Improvement of bone turnover markers and bone mineral density following treatment of primary aldosteronism

Loh, Huai Heng; Kamaruddin, Nor Azmi; Zakaria, Ros Mahwati Ahmad; Sukor, Norlela

doi:10.23736/s0391-1977.16.02553-0

Cited by 6 publications

(29 citation statements)

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“…Patients with bilateral PA undergoing MRA treatment had a significant decrease of BAP, osteocalcin and PINP as well as the bone resorption marker TrAP, which is in accordance with findings from Loh et al [ 15 ]. In contrast, patients with unilateral disease who underwent ADX demonstrated no significant changes in bone turnover markers.…”

Section: Discussionsupporting

confidence: 91%

“…Based on the findings that in postmenopausal women higher bone turnover markers are supposed to indicate rapid bone loss and bone markers being higher in women after fractures those findings could reflect an improvement of bone quality and probably also in bone mass in patients with PA undergoing treatment with MRA but not with ADX [ 42 , 43 ]. Spironolactone itself has been frequently reported to improve bone health in different cohorts of patients [ 15 , 44 , 45 ]. One major point of the bone protective effect of spironolactone could be its antimineralocorticoid effect, enabling enhanced tubular reabsorption of calcium resulting in higher serum calcium levels and a decrease in PTH, which would be in line with effects of thiazide diuretics which have been shown to be beneficial for bone health in the setting of hypertension [ 8 , 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

“…Contrary, Loh et al reported higher levels of bone formation marker intact procollagen I N-terminal propeptide (PINP) and resorption marker carboxy-terminal collagen crosslinks (CTX-1) in 18 patients with PA compared with 17 patients with essential hypertension. Furthermore, they found a significant decrease in PINP and CTX-1 following specific treatment by unilateral ADX ( n = 3) or MRA ( n = 12) [ 15 ]. These conflicting results may have been influenced by both insufficient matching for sex, BMI, and age at baseline and furthermore by not taking into account sex or gonadal status as well as treatment strategy, either ADX or MRA, for PA [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, they found a significant decrease in PINP and CTX-1 following specific treatment by unilateral ADX ( n = 3) or MRA ( n = 12) [ 15 ]. These conflicting results may have been influenced by both insufficient matching for sex, BMI, and age at baseline and furthermore by not taking into account sex or gonadal status as well as treatment strategy, either ADX or MRA, for PA [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Spironolactone reduces biochemical markers of bone turnover in postmenopausal women with primary aldosteronism

et al. 2020

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Context: Primary aldosteronism (PA) is the most frequent form of endocrine hypertension.Besides its deleterious impact on cardiovascular target organ damage, PA is considered to cause osteoporosis. Patients and Methods:We assessed bone turnover in a subset of 36 postmenopausal women with PA. Eighteen patients had unilateral PA and were treated by adrenalectomy, whereas eighteen patients had bilateral PA and received mineralocorticoid receptor antagonist (MRA) therapy respectively. Eighteen age-and BMI-matched females served as controls. To estimate bone remodelling, we measured the bone turnover markers intact procollagen 1 N-terminal propeptide, bone alkaline phosphatase, osteocalcin and tartrate resistant acid phosphatase 5b in plasma by chemiluminescent immunoassays at time of diagnosis and one year after initiation of treatment. Study design:Observational longitudinal cohort study. Setting: Tertiary care hospital.Results: Compared to controls, patients with PA had mildly elevated osteocalcin at baseline (p= 0.013), while the other bone markers were comparable between both groups. There were no differences between the unilateral and the bilateral PA subgroup. One year after initiation of MRA treatment with spironolactone bone resorption and bone formation markers had significantly decreased in patients with bilateral PA. In contrast, patients adrenalectomized because of unilateral PA showed no significant change of bone turnover markers. Conclusion:This study shows that aldosterone excess in postmenopausal women with PA is not associated with a relevant increase of bone turnover markers at baseline. However, we observed a

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Spironolactone reduces biochemical markers of bone turnover in postmenopausal women with primary aldosteronism

et al. 2020

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“…Eighteen articles were included in the meta-analysis. In detail, 12 studies ( 14 , 17 , 18 , 21 , 25 – 27 , 29 – 33 ) compared 3,318 PA patients to 11,024 essential hypertension (EH) subjects in terms of the serum calcium and urinary calcium levels; the serum PTH, 25-OHD, and AKP levels; and the BMD. Twelve studies ( 17 ), ( 18 ), ( 25 ), ( 27 , 29 – 31 ), ( 12 , 15 , 16 , 28 , 33 ) compared 501 PA patients before medical or surgical treatment to 491 who were followed-up after treatment in terms of the serum calcium and urinary calcium levels; the serum PTH, 25-OHD, and BAP levels; and the BMD.…”

Section: Resultsmentioning

confidence: 99%

Bone and mineral metabolism in patients with primary aldosteronism: A systematic review and meta-analysis

Wang

Liu³

et al. 2022

Front. Endocrinol.

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PurposePatients with primary aldosteronism (PA) tend to exhibit a high prevalence of osteoporosis (OP) that may vary by whether PA is unilateral or bilateral, and responsive to PA treatment. To explore relationships between bone metabolism, PA subtypes, and treatment outcomes, we performed a systematic review and meta-analysis.MethodsThe PubMed, Embase, and Cochrane databases were searched for clinical studies related to PA and bone metabolism markers. Articles that met the criteria were screened and included in the systematic review; the data were extracted after evaluating their quality. R software (ver. 2022-02-16, Intel Mac OS X 11.6.4) was used for the meta-analysis.ResultsA total of 28 articles were subjected to systematic review, of which 18 were included in the meta-analysis. We found that PA patients evidenced a lower serum calcium level (mean difference [MD] = –0.06 mmol/L, 95% confidence interval [CI]: −0.10 ~ −0.01), a higher urine calcium level (MD = 1.29 mmol/24 h, 95% CI: 0.81 ~ 1.78), and a higher serum parathyroid hormone (PTH) level (MD = 2.16 pmol/L, 95% CI: 1.57 ~ 2.75) than did essential hypertension (EH) subjects. After medical treatment or adrenal surgery, PA patients exhibited a markedly increased serum calcium level (MD = –0.08 mmol/L, 95% CI: –0.11 ~ –0.05), a decreased urine calcium level (MD = 1.72 mmol/24 h, 95% CI: 1.00 ~ 2.44), a decreased serum PTH level (MD = 2.67 pmol/L, 95% CI: 1.73 ~ 3.62), and an increased serum 25-hydroxyvitamin D (25-OHD) level (MD = –6.32 nmol/L, 95% CI: –11.94 ~ –0.70). The meta-analysis showed that the ser um PTH level of unilateral PA patients was significantly higher than that of bilateral PA patients (MD = 0.93 pmol/L, 95% CI: 0.36 ~ 1.49) and the serum 25-OHD lower than that of bilateral PA patients (MD = –4.68 nmol/L, 95% CI: –7.58 ~ 1.77). There were, however, no significant differences between PA and EH patients of 25-OHD, or BMD of femoral neck and lumbar spine. BMDs of the femoral neck or lumbar spine did not change significantly after treatment. The meta-analytical results were confirmed via sensitivity and subgroup analyses.ConclusionExcess aldosterone was associated with decreased serum calcium, elevated urinary calcium, and elevated PTH levels; these effects may be enhanced by low serum 25-OHD levels. The risks of OP and fracture might be elevated in PA patients, especially unilateral PA patients, but could be reduced after medical treatment or adrenal surgery. In view, however, of the lack of BMD changes, such hypothesis needs to be tested in further studies.

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Adrenocortical incidentalomas and bone: from molecular insights to clinical perspectives

et al. 2018

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Adrenal incidentalomas constitute a common clinical problem with an overall prevalence of around 2-3%, but are more common with advancing age being present in 10% of those aged 70 years. The majority of these lesions are benign adrenocortical adenomas (80%), characterized in 10-40% of the cases by autonomous cortisol hypersecretion, and in 1-10% by aldosterone hypersecretion. Several observational studies have shown that autonomous cortisol and aldosterone hypersecretion are more prevalent than expected in patients with osteopenia and osteoporosis: these patients have accelerated bone loss and an increased incidence of vertebral fractures. In contrast to glucocorticoid action, the effects of aldosterone on bone are less well understood. Recent data, demonstrating a concomitant co-secretion of glucocorticoid metabolites in patients with primary aldosteronism, could explain some of the metabolic abnormalities seen in patients with aldosterone hypersecretion. In clinical practice, patients with unexplained osteoporosis, particularly when associated with other features such as impaired glucose tolerance or hypertension, should be investigated for the possible presence of autonomous cortisol or aldosterone secretion due to an adrenal adenoma. Randomized intervention studies are needed, however, to investigate the optimum interventions for osteoporosis and other co-morbidities in these patients.

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Improvement of bone turnover markers and bone mineral density following treatment of primary aldosteronism

Cited by 6 publications

References 0 publications

Spironolactone reduces biochemical markers of bone turnover in postmenopausal women with primary aldosteronism

Spironolactone reduces biochemical markers of bone turnover in postmenopausal women with primary aldosteronism

Bone and mineral metabolism in patients with primary aldosteronism: A systematic review and meta-analysis

Adrenocortical incidentalomas and bone: from molecular insights to clinical perspectives

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