Prednisolone is associated with a worse bone mineral density in primary adrenal insufficiency

Kathrin Frey, Tina Kienitz, Julia Schulz, Manfred Ventz, Kathrin Zopf and Marcus Quinkler⇑

Endocr Connect 2018 EC-18-0160 doi: 10.1530/EC-18-0160



Context: Patients with primary adrenal insufficiency (PAI) or congenital adrenal hyperplasia (CAH) receive life-long glucocorticoid (GC) therapy. Daily GC doses are often above the physiological cortisol production rate and can cause long-term morbidities such as osteoporosis. No prospective trial has investigated long-term effect of different GC-therapies on bone mineral density (BMD) in those patients.


Objectives: To determine if patients on hydrocortisone (HC) or prednisolone show changes in BMD after follow-up of 5.5 years. To investigate if BMD is altered after switching from immediate- to modified-release HC.


Design and Patients: Prospective, observational, longitudinal study with evaluation of BMD by DXA at visit1, after 2.2±0.4 (visit2) and after 5.5±0.8 years (visit3) included 36 PAI and 8 CAH patients. 13 patients received prednisolone (age 52.5±14.8yrs; 8 women), 31 patients immediate-release HC (age 48.9±15.8yrs; 22 women). 12 patients on immediate-release switched to modified-release HC at visit2.


Results: Prednisolone showed significantly lower Z-scores compared to HC at femoral neck (-0.85±0.80 vs -0.25±1.16, p<0.05), trochanter (-0.96±0.62 vs 0.51±1.07, p<0.05) and total hip (-0.78±0.55 vs 0.36±1.04, p<0.05), but not at lumbar spine, throughout the study. Prednisolone dose decreased by 8% over study time, but no significant effect was seen on BMD. BMD did not change significantly after switching from immediate- to modified-release HC.


Conclusions: The use of prednisolone as hormone replacement therapy results in significantly lower BMD compared to HC. Patients on low dose HC replacement therapy showed unchanged Z-scores within the normal reference range during the study period.


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