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Osteoporosis in Adrenal Insufficiency: Could Metformin be Protective?

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Abstract

Adrenal insufficiency (AI) is a serious disorder characterized by the adrenal glucocorticoid deficiency. Regardless of the etiology, AI patients need long-term replacement therapy for glucocorticoids and, in some cases, for mineralocorticoids. The replacement therapy cannot completely mirror the physiological secretion patterns, and therefore, glucocorticoid excess is a common sequela in AI patients. Moreover, due to the absence of the reliable clinical markers to monitor the adequacy of the replacement therapy, clinicians often over-treat the AI patients to avoid adrenal crisis. Long-term glucocorticoid use is associated with the loss of bone density and osteoporosis, increasing the risk of fractures. Moreover, glucocorticoid-induced hyperglycemia and type 2 diabetes mellitus further aggravates the bone disorders. In the recent years, ameliorating effects of metformin on glucocorticoid-induced bone disorders, as well as hyperglycemia, have been reported by a multitude of studies; and here, we reviewed and discussed the most recent findings regarding the positive effects of metformin on alleviating the bone disorders, and their implications in the AI patients.

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Authors and Affiliations

  1. College of Medicine, University of Thi-Qar, Al-Nasiriyah, Thi-Qar, Iraq

    Abduladheem Turki Jalil

  2. Department of Medical Laboratory Techniques, Al-Maarif University College, Al-Anbar, Iraq

    Mohanad Ali Abdulhadi

  3. College of Pharmacy, Al-Zahraa University for Women, Karbala, Iraq

    Lubna R. Al-Ameer

  4. National University of Science and Technology, Al-Nasiriyah, Thi-Qar, Iraq

    Zahraa Hamzaa Abd-Alzahraa

  5. Prosthetic Dental Techniques Department, Al-Mustaqbal University College, Hillah, Babylon, Iraq

    Muna S. Merza

  6. Medical Laboratory Technology Department, College of Medical Technology, The Islamic University of Najaf, Najaf, Iraq

    Rahman S. Zabibah

  7. Medical Technical College, Al-Farahidi University, Baghdad, Iraq

    Hala Bahair

  8. College of Nursing, Al-Kitab University, Kirkuk, Iraq

    Marghoob Hussein Yaas

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  1. Abduladheem Turki Jalil
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Jalil, A.T., Abdulhadi, M.A., Al-Ameer, L.R. et al. Osteoporosis in Adrenal Insufficiency: Could Metformin be Protective?. Ind J Clin Biochem (2023). https://doi.org/10.1007/s12291-023-01153-0

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