Vaňuga Peter, Ságová Ivana
Vnitr Lek. 2021 Winter;67(5):264-269.
The aim of the study was to assess the effect of glucocorticoid replacement therapy in patients with Addison´s disease on bone mineral density (BMD), parameters of calcium - phosphate (Ca-P) metabolism as well as on bone turneover markers.
The study group consisted of 46 patients with Addison´s disease (12men, 17 pre- and 17 postmenopausal women, the control group consisted of 44 healthy individuals (8 men, 16 prepre- and 16 postmenopausal women). Ca-P metabolism parameters, bone turnover markers and adrenal hormones were examined in all groups. BMD was measured by dual-energy X-ray absorptiometry in the lumbar spine (BMD lumb) and forearm (BMDfore).
We did not confirm an increased prevalence of osteoporosis and osteopenia in patients with Addison´s disease. BMD values did not correlate with hydrocortisone (HCT) doses, HCT doses calculated on body weight and body surface area as well as with duration of substitution treatment. Patients with daily HCT doses > 25 mg had significantly lower BMD in lumbar spine compared with patients with daily HCT doses 25 mg. In study group we observed decreased levels of adrenal androgens, in women also estradiol. Decreased level of serum calcium and increased level of osteocalcin, bone alkaline phosphatase, 25- hydroxyvitamin D were present in women with Addison´s disease. RANKL/OPG ratio was higher in patients with Addison´s disease compared with controls.
Glucocorticoid replacement therapy is not a significant risk factor for development of osteoporosis in patients with Addison disease, because this therapy only physiologically replaces endogenous cortisol deficiency. An increased RANKL / OPG ratio may indicate a relative lack of OPG. It is possible that female patients, despite adequate substitution, have an increased bone turnover and a relatively higher risk of decrease in BMD. Potential risks are higher doses of glucocorticoid replacement therapy (HCT > 25 mg daily) and a typical steroid constellation (decreased adrenocortical androgens DHEA and DHEAS and in women also estradiol).
本研究旨在评估艾迪生病患者接受糖皮质激素替代治疗对骨密度（BMD）、钙磷（Ca-P）代谢参数以及骨转换标志物的影响。
研究组由46例艾迪生病患者组成（12例男性，17例绝经前女性和17例绝经后女性），对照组由44例健康个体组成（8例男性，16例绝经前女性和16例绝经后女性）。对所有组检测Ca-P代谢参数、骨转换标志物和肾上腺激素。采用双能X线吸收法测量腰椎（BMD腰）和前臂（BMD前臂）的骨密度。
我们未证实艾迪生病患者骨质疏松和骨质减少的患病率增加。BMD值与氢化可的松（HCT）剂量、按体重和体表面积计算的HCT剂量以及替代治疗持续时间均无相关性。每日HCT剂量>25mg的患者与每日HCT剂量≤25mg 的患者相比，腰椎BMD显著更低）研究组中我们观察到肾上腺雄激素水平降低，女性患者中雌二醇水平也降低。艾迪生病女性患者血清钙水平降低而骨钙素、骨碱性磷酸酶、25-羟维生素D水平升高。艾迪生病患者的RANKL/OPG比值高于对照组。
糖皮质激素替代治疗并非艾迪生病患者发生骨质疏松的显著危险因素，因为该治疗仅在生理上替代内源性皮质醇缺乏。RANKL/OPG比值升高可能表明OPG相对缺乏）尽管进行了充分替代，女性患者仍可能有骨转换增加以及BMD降低的相对较高风险。潜在风险为更高剂量的糖皮质激素替代治疗（每日HCT>mg）以及典型的类固醇状态（肾上腺皮质雄激素脱氢表雄酮和硫酸脱氢表雄酮降低，女性患者中雌二醇也降低）。
