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Endocrine Care: Jeremy A. King, Amy B. Wisniewski, Brandon J. Bankowski, Kathryn A. Carson, Howard A. Zacur, and Claude J. Migeon Long-Term Corticosteroid Replacement and Bone Mineral Density in Adult Women with Classical Congenital Adrenal Hyperplasia J Clin Endocrinol Metab 2006; 91: 865-869 [Abstract] [Full text] [PDF]

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Glucocorticoids are not harmful to bone in adult women with classical congenital adrenal hyperplasia

Nelson B. Watts   (7 June 2006)

Glucocorticoids are not harmful to bone in adult women with classical congenital adrenal hyperplasia 7 June 2006
Nelson B. Watts University of Cincinnati Send letter to journal: Re: Glucocorticoids are not harmful to bone in adult women with classical congenital adrenal hyperplasia nelson.watts{at}uc.edu Nelson B. Watts	In their otherwise informative paper on long-term corticosteroid replacement and bone density in adult women with classical congenital adrenal hyperplasia (CAH), King et al. (1) conclude that “osteopenia was noted in 45% of [salt losing] CAH, 13% of patients with the simple virilizing form and 11% of controls.” This statement is true but irrelevant. The prevalence of “osteopenia” is not the correct measure. “Osteopenia” and “osteoporosis” are arbitrary categories whose prevalence is influenced strongly by age. Sixteen percent of a healthy young population would have bone mineral density 1 SD or more below the young adult mean; the number increases as the population ages. The average age of the salt-losing CAH patients was 39 years, and 10% were postmenopausal; the average age of the simple virilizing CAH patients was 51 years, and 15% were postmenopausal. Consequently, it is not surprising that more than 16% were greater than 1 SD below the young adult mean. The correct measure of how bone density compares with what is expected, the Z-score, was essentially normal in the salt-losing patients (-0.15±1.22) and above average (but overlapping average) in the simple virilizing patients (+1.05±1.42). The authors' conclusion that “adult women with classical CAH treated with long-term glucocorticoids are at risk for depressed BMD” is not supported by their findings. On the contrary, the most notable finding of this study is that these patients, despite years of glucocorticoid therapy – though perhaps offset by androgen excess-- had bone density that was about average for age and sex. Reference 1. King JA, Wisniewski AB, Bankowski BJ, Carson KA, Zacur HA, and Migeon CJ. 2006. Long-Term Corticosteroid Replacement and Bone Mineral Density in Adult Women with Classical Congenital Adrenal Hyperplasia. J Clin Endo Metab 91:865-869