Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, Poznań, Poland.
Ludwik Perzyna Regional Hospital, Kalisz, Poland.
Endocrine. 2024 May;84(2):711-719. doi: 10.1007/s12020-024-03709-3. Epub 2024 Feb 9.
Patients receiving long-term glucocorticoid (GC) treatment are at risk of osteoporosis, while bone effects of substitution doses in Addison's disease (AD) remain equivocal. The project was aimed to evaluate serum bone turnover markers (BTMs): osteocalcin, type I procollagen N-terminal propeptide (PINP), collagen C-terminal telopeptide (CTX), sclerostin, DKK-1 protein, and alkaline phosphatase (ALP) in relation to bone mineral density (BMD) during GC replacement.
Serum BTMs and hormones were assessed in 80 patients with AD (22 males, 25 pre- and 33 postmenopausal females) on hydrocortisone (HC) substitution for ≥3 years. Densitometry with dual-energy X-ray absorptiometry covered the lumbar spine (LS) and femoral neck (FN).
Among BTMs, only PINP levels were altered in AD. BMD Z-scores remained negative except for FN in males. Considering T-scores, osteopenia was found in LS in 45.5% males, 24% young and 42.4% postmenopausal females, while osteoporosis in 9.0%, 4.0% and 21.1%, respectively. Lumbar BMD correlated positively with body mass (p = 0.0001) and serum DHEA-S (p = 9.899 × 10). Negative correlation was detected with HC dose/day/kg (p = 0.0320), cumulative HC dose (p = 0.0030), patient's age (p = 1.038 × 10), disease duration (p = 0.0004), ALP activity (p = 0.0041) and CTX level (p = 0.0105). However, only age, body mass, ALP, serum CTX, and sclerostin remained independent predictors of LS BMD.
Standard HC substitution does not considerably accelerate BMD loss in AD patients and their serum BTMs: CTX, osteocalcin, sclerostin, DKK-1, and ALP activity remain within the reference ranges. Independent predictors of low lumbar spine BMD, especially ALP activity, serum CTX and sclerostin, might be monitored during GC substitution.
接受长期糖皮质激素（GC）治疗的患者有发生骨质疏松的风险，而在 Addison 病（AD）中替代剂量的骨效应仍存在争议。该项目旨在评估血清骨转换标志物（BTMs）：骨钙素、I 型前胶原 N 端前肽（PINP）、胶原 C 端肽（CTX）、骨硬化蛋白、DKK-1 蛋白和碱性磷酸酶（ALP）与 GC 替代期间的骨矿物质密度（BMD）的关系。
对 80 例接受氢化可的松（HC）替代治疗≥3 年的 AD 患者（22 名男性，25 名绝经前和 33 名绝经后女性）进行血清 BTM 和激素评估。双能 X 射线吸收法测量腰椎（LS）和股骨颈（FN）的骨密度。
在 AD 中，只有 PINP 水平发生改变。BMD Z 评分仍为负数，除男性 FN 外。考虑 T 评分，45.5%的男性、24%的年轻女性和 42.4%的绝经后女性 LS 存在骨质疏松，9.0%、4.0%和 21.1%分别存在骨质疏松。LS 骨密度与体重呈正相关（p=0.0001）和血清 DHEA-S（p=9.899×10）。与 HC 剂量/天/kg（p=0.0320）、累积 HC 剂量（p=0.0030）、患者年龄（p=1.038×10）、疾病持续时间（p=0.0004）、ALP 活性（p=0.0041）和 CTX 水平（p=0.0105）呈负相关。然而，只有年龄、体重、ALP、血清 CTX 和骨硬化蛋白是 LS BMD 的独立预测因子。
标准 HC 替代治疗在 AD 患者中不会明显加速 BMD 丢失，其血清 BTMs：CTX、骨钙素、骨硬化蛋白、DKK-1 和 ALP 活性仍在参考范围内。GC 替代期间，低 LS BMD 的独立预测因子，特别是 ALP 活性、血清 CTX 和骨硬化蛋白，可能需要监测。
