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Vertebral fractures assessed with dual-energy X-ray absorptiometry in patients with Addison’s disease on glucocorticoid and mineralocorticoid replacement therapy

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Abstract

Purpose

to assess bone damage and metabolic abnormalities in patients with Addison’s disease given replacement doses of glucocorticoids and mineralocorticoids.

Methods

A total of 87 patients and 81 age-matched and sex-matched healthy controls were studied. The following parameters were measured: urinary cortisol, serum calcium, phosphorus, creatinine, 24-h urinary calcium excretion, bone alkaline phosphatase, parathyroid hormone, serum CrossLaps, 25 hydroxyvitamin D, and 1,25 dihydroxyvitamin D. Clear vertebral images were obtained with dual-energy X-ray absorptiometry in 61 Addison’s disease patients and 47 controls and assessed using Genant’s classification.

Results

Nineteen Addison’s disease patients (31.1%) had at least one morphometric vertebral fracture, as opposed to six controls (12.8%, odds ratio 3.09, 95% confidence interval 1.12–8.52). There were no significant differences in bone mineral density parameters at any site between patients and controls. In Addison’s disease patients, there was a positive correlation between urinary cortisol and urinary calcium excretion. Patients with fractures had a longer history of disease than those without fractures. Patients taking fludrocortisone had a higher bone mineral density than untreated patients at all sites except the lumbar spine.

Conclusions

Addison’s disease patients have more fragile bones irrespective of any decrease in bone mineral density. Supra-physiological doses of glucocorticoids and longer-standing disease (with a consequently higher glucocorticoid intake) might be the main causes behind patients’ increased bone fragility. Associated mineralocorticoid treatment seems to have a protective effect on bone mineral density.

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Funding

This study was supported in part by a grant from the EU 7th Framework Programme, EurAdrenal project: Pathophysiology and Natural Course of Autoimmune Adrenal Failure in Europe. Grant No. 2008-201167; and by a grant ex 60% from the of University of Padua.

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Authors and Affiliations

  1. Department of Medicine, Endocrinology Division, University of Padua, Via Ospedale 105, Padua, 35128, Italy

    Valentina Camozzi, Corrado Betterle, Veronica Zaccariotto, Erica De Caneva, Paola Lucato, Walter Gomiero, Silvia Garelli, Chiara Sabbadin, Monica Salvà, Miriam Dalla Costa, Marco Boscaro & Giovanni Luisetto

  2. Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology and Public Health Unit, University of Padua, Via Loredan 18, Padua, 35131, Italy

    Anna Chiara Frigo

  3. Department of Laboratory Medicine, University of Padua, Via Giustiniani 2, Padua, 35128, Italy

    Martina Zaninotto

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  1. Valentina Camozzi
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Correspondence to Corrado Betterle.

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Camozzi, V., Betterle, C., Frigo, A.C. et al. Vertebral fractures assessed with dual-energy X-ray absorptiometry in patients with Addison’s disease on glucocorticoid and mineralocorticoid replacement therapy. Endocrine 59, 319–329 (2018). https://doi.org/10.1007/s12020-017-1380-8

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