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Association of androgen excess and bone mineral density in women with classical congenital adrenal hyperplasia with 21-hydroxylase deficiency

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Abstract

Summary

The relationship between androgen excess and bone health in patients with congenital adrenal hyperplasia (CAH) with 21-hydroxylase (21-OH) deficiency is not fully understood. This study demonstrated positive correlations between androgen hormones and bone mineral density (BMD) in CAH women with 21-OH deficiency.

Purpose

This study aims to assess BMD and its association with androgen excess in women with CAH.

Methods

We enrolled 92 women with CAH with 21-OH deficiency and retrospectively reviewed their clinical features, hormone concentrations, body composition, glucocorticoid (GC) dose, and BMD.

Results

BMD was not different according to the subtypes of CAH. BMD at the lumbar spine was lower in women with CAH with regular menstruation than those with irregular menstruation (1.081 vs. 1.165 g/cm2, P < 0.05). BMD was lower in women with CAH with 17-hydroxyprogesterone (17-OHP) < 10 ng/mL than in those with ≥ 10 ng/mL (lumbar spine, 1.019 vs. 1.150 g/cm2; femur neck, 0.806 vs. 0.899 g/cm2; total hip, 0.795 vs. 0.943 g/cm2; all P < 0.05). After adjusting for age and BMI in correlation analyses, testosterone concentrations were positively correlated with lumbar spine, femur neck, and total hip BMD (r = 0.46, r = 0.38, and r = 0.35, respectively; all P < 0.05), while 17-OHP was positively correlated with lumbar spine BMD (r = 0.38, P < 0.01). In subgroup analysis, 17-OHP was positively correlated with BMD (lumbar spine, r = 0.22; femur neck, r = 0.22; total hip, r = 0.24; all P < 0.05) only in the group with a total cumulative dose of GC ≥ 156.0 g/m2.

Conclusion

Androgen excess may have a protective effect on BMD in women with classic CAH and high cumulative doses of GC.

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Acknowledgements

We are grateful to Sei Won Yang, the emeritus professor of pediatrics at Seoul National University College of Medicine, and Seong Yeon Kim, the emeritus professor of internal medicine at Seoul National University College of Medicine.

Funding

This study was funded by a donation from one CAH patient.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea

    Dong Ho Lee, Han Na Jang, Seung Gyun Lim & Jung Hee Kim

  2. Department of Internal Medicine, Seoul National University College of Medicine, 101 Dae-hak ro, Jongno gu, Seoul, 03080, Korea

    Dong Ho Lee, Sung Hye Kong, Han Na Jang, Chang Ho Ahn, Seung Gyun Lim, Sang Wan Kim & Jung Hee Kim

  3. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea

    Sung Hye Kong & Chang Ho Ahn

  4. Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, South Korea

    Young Ah Lee

  5. Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea

    Sang Wan Kim

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  1. Dong Ho Lee
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Contributions

DHL, SHK, and JHK conceived and designed the analysis. DHL, SHK, HNJ, SGL, YAL, and JHK collected the data. All authors contributed to data analysis and interpretation. DHL and JHK drafted the manuscript, and all authors provided critical revisions. All authors gave final approval of the version of the manuscript submitted for publication.

Corresponding author

Correspondence to Jung Hee Kim.

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Ethics approval

This study was performed in accordance with the principles of the Declaration of Helsinki. The Seoul National University Hospital Institutional Review Board (H-2004–147-1118) approved this study.

Consent to participate

This study waived the requirement for informed consent.

Conflict of interest

The authors declare no competing interests.

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Lee, D.H., Kong, S.H., Jang, H.N. et al. Association of androgen excess and bone mineral density in women with classical congenital adrenal hyperplasia with 21-hydroxylase deficiency. Arch Osteoporos 17, 45 (2022). https://doi.org/10.1007/s11657-022-01090-0

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