Sexual Difference in Bone Geometry of Adult Patients with Classical Congenital Adrenal Hyperplasia: Data Using Peripheral Quantitative Computed Tomography

Abstract

Background/Aims: Glucocorticoid treatment may influence bone and muscle development in patients with congenital adrenal hyperplasia (CAH). This study evaluated bone mineral density (BMD), bone geometry and muscle mass. Methods: 73 adult patients with classical CAH were followed. BMD, bone geometry and muscle mass were measured using peripheral quantitative computed tomography (pQCT). Glucocorticoid-equivalent doses throughout life were calculated and at the time pQCT androgen levels were measured. Results: In males the mean standard deviation (SD) score for trabecular BMD (-0.33 ± 0.71) was reduced, whereas mean cortical BMD (1.05 ± 1.11) was elevated. Mean total (0.86 ± 1.12) and medullary cross-sectional area (CSA; 1.12 ± 1.17) were significantly increased (p < 0.001). In all patients SD scores for cortical thickness (-0.65 ± 0.91) and muscle CSA (-0.83 ± 0.91) were reduced. Treatment duration was associated with lower trabecular BMD in males (r = -0.63, p < 0.001). Suppressed androgens and simple virilizing CAH had an adverse effect on the muscle CSA SD score (OR 0.58 and 0.46, respectively, p < 0.05). Conclusion: There was a sexual difference with enlarged total and medullary CSA in females, whereas in males trabecular BMD was reduced and cortical BMD elevated. Cortical thickness and muscle CSA were reduced in all CAH patients with a possible long-term impact on bone development and stability. Monitoring of bone and muscle development might be warranted.

A Piece of the Puzzle: The Bone Health Index of the BoneXpert Software Reflects Cortical Bone Mineral Density in Pediatric and Adolescent Patients

“…Assessment of bone health in pediatric patients with chronic disease relies on the interpretation of clinical, biochemical and radiographic surrogate parameters by the treating physician[ 32 – 35 ]. One important piece of the puzzle is the assessment of BMD in children and adolescents[ 2 , 36 , 37 ]. The present study was undertaken to assess how the BHI[ 17 ] embedded in the program BoneXpert compares with pediatric bone mineral density readings assessed by two other methods, DXA and pQCT.…”

Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance

“…Bone density (total and medullary cross-sectional area) is increased in women with CAH with variably elevated serum testosterone (including into the male range) when it is only partially suppressed by glucocorticoid treatment (143), although more effective glucocorticoid suppression lowers bone density (144).…”

Do anabolic-androgenic steroids have performance-enhancing effects in female athletes?

“…Additionally, the medications that are used to treat CAH (in particular glucocorticoids) may also negatively impact physical performance due to their catabolic effects on skeletal muscle (Angoorani et al, 2012). Indeed, in a prospective study of adult patients with classic CAH who were on glucocorticoid replacement, both female and male patients demonstrated reduced muscle mass (Bechtold et al, 2014). Thus, it remains unclear whether CAH (and its treatment) positively or negatively impacts athletic performance.…”