Skeletal Microstructure in Addison's Disease

Le résumé fourni par la source

Abstract Context Addison's disease (AD) is characterized by deficient adrenal glucocorticoid (GC) production. Treatment involves just GC replacement, but patients often receive high doses, leading to side effects. Bone mineral density (BMD) data in AD are conflicting. High-resolution peripheral quantitative computed tomography (HRpQCT) evaluates volumetric BMD, microarchitecture, and mechanical properties of the tibia and radius. No studies have assessed bone quality by HRpQCT on subjects with AD. Objective Evaluate the bone health of patients with AD using HRpQCT. Design Cross-sectional study. Setting Ambulatory of a tertiary medical center. Participants Nineteen patients with AD on GC were compared to 38 matched controls. Main Outcome Measures Dual-energy x-ray absorptiometry and HRpQCT measurements. Results Patients with AD had lower lean mass and BMD. At the radius, the AD group had 11% lower trabecular (Tb) number (P = .03). At the tibia, patients had lower Tb number and Tb volumetric BMD, greater Tb separation, and lower cortical area and thickness (17-26% difference in these parameters, P < .03 for all). Tibial stiffness was 21% lower in the AD group (P < .03). In this group, there was a positive correlation between lean mass and stiffness (radius r = 0.53, tibia r = 0.51; both P < .04) and a negative correlation between cumulative GC dose and spine BMD (r = −0.67, P < .01). Conclusion This is the first study to assess bone using HRpQCT in patients with AD on GC. Our findings suggest that AD patients have a loss of lean mass and skeletal fragility, mainly of the trabecular compartment and at the tibia. Bone loss may be related to loss of lean mass and GC.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.