Department of Endocrinology, Royal Darwin Hospital, Darwin, NT, Australia.
Department of Endocrinology, Gold Coast University Hospital, Southport, QLD, Australia.
Endocrine. 2021 Oct;74(1):29-37. doi: 10.1007/s12020-021-02723-z. Epub 2021 Apr 12.
The association between glucocorticoid replacement therapy for adrenal insufficiency (AI) and osteoporosis is unclear. Fracture is a major cause of morbidity in patients with osteoporosis. This study aims to determine if patients on glucocorticoid replacement therapy for AI have an increased rate of fractures compared to the general population.
We included all studies with adult patients receiving glucocorticoid replacement therapy for either congenital adrenal hyperplasia (CAH), primary adrenal insufficiency (PAI), or secondary adrenal insufficiency (SAI). Studies without fracture data were excluded, as well as meeting abstracts. Studies with fractures but without a control group were eligible to be included in the systematic review but not in the meta-analysis. The primary outcome was the number of fractures, which was further differentiated into osteoporotic fractures. In addition, the glucocorticoid dose equivalents used were noted whenever possible.
Seventeen studies were included in the systematic review. Seven were used in the meta-analysis of any fracture and six were used for osteoporotic fracture. The reported fracture rate ranged between no fracture to 60.8% in the patient group and no fracture to 43.8% in the control group. The odds ratio (OR) for any fracture was 2.71 (95%CI: 1.36-5.43, P = 0.005) and for osteoporotic fracture 2.76 (95%CI: 2.39-3.19 P < 0.00001), favoring the control group.
Patients with AI on glucocorticoid replacement therapy have a higher rate of fractures compared to the control population.
肾上腺皮质功能不全（AI）患者接受糖皮质激素替代治疗与骨质疏松症之间的关系尚不清楚。骨折是骨质疏松症患者发病和致残的主要原因。本研究旨在确定 AI 患者接受糖皮质激素替代治疗的骨折发生率是否高于普通人群。
我们纳入了所有接受糖皮质激素替代治疗的成人患者的研究，包括先天性肾上腺皮质增生症（CAH）、原发性肾上腺皮质功能减退症（PAI）或继发性肾上腺皮质功能减退症（SAI）。排除了没有骨折数据的研究，以及会议摘要。虽然有骨折但没有对照组的研究有资格被纳入系统评价，但不能纳入荟萃分析。主要结局是骨折数量，并进一步分为骨质疏松性骨折。此外，尽可能记录了使用的糖皮质激素等效剂量。
共纳入了 17 项系统评价研究。7 项研究用于任何骨折的荟萃分析，6 项研究用于骨质疏松性骨折。报告的骨折发生率在患者组为无骨折至 60.8%，在对照组为无骨折至 43.8%。任何骨折的比值比（OR）为 2.71（95%CI：1.36-5.43，P=0.005），骨质疏松性骨折的 OR 为 2.76（95%CI：2.39-3.19，P<0.00001），对照组更有利。
接受糖皮质激素替代治疗的 AI 患者骨折发生率高于对照组人群。
