Prevalence and Predictive Factors of Low-Bone Mineral Density in Patients with Addison Disease on Long-Term Corticosteroid Replacement Therapy

Abstract

Addison disease (AD) is associated with high risk of decreased bone mineral density (BMD) and osteoporosis. Causes are complex, including lifelong glucocorticoid replacement therapy. The aim of our study was to assess the influence of glucorticoid replacement therapy on BMD among patients with AD and determine predictive factors of low BMD. A descriptive and analytical cross-sectional study was conducted at the department of endocrinology-diabetology at HediChaker Hospital, including 50 patients with AD for at least 5 years. Serum levels of bone turnover markers were measured and BMD was determined. The mean age of patients was 49.5 ± 13.9 years. Received average daily dose of hydrocortisone (HC) was 27.4 ± 6.7 mg. Mean cumulative HC dose was 374.636 ± 283.821 mg. Mean T-score at lumbar spine and femoral neck was –0.61 ± 1.06 (range,–4.2–1.1) and –1.18 ± 1.33 (range,–2.9–1.3), respectively. Low BMD was observed in 48% of patients. No fracture was observed. Patients who developed osteoporosis were significantly older than those with normal BMD (p = 0.018). Menopause was a significant predictor of incident osteoporosis (p = 0.006). Furthermore, osteoporosis was significantly more prevalent among females (p = 0.046). Daily and cumulative HC dose were higher in patients with osteoporosis than those with normal osteodensitometry. Glucocorticoid replacement therapy in AD may induce bone loss. Thus, glucocorticoid therapy must be adjusted to the lowest tolerable dose.