PDF(Pubmed)
Abstract：
UNASSIGNED: Patients with primary (PAI) and secondary adrenal insufficiency (SAI) experience bone metabolism alterations, possibly due to excessive replacement. Dual-release hydrocortisone (DR-HC) has shown promising effects on several parameters, but bone metabolism has seldom been investigated.
UNASSIGNED: We evaluated the long-term effects of once-daily DR-HC on bone in PAI and SAI.
UNASSIGNED: Patients on immediate-release glucocorticoid therapy were evaluated before and up to 6 years (range, 4-6) after switching to equivalent doses of DR-HC, yielding data on bone turnover markers, femoral and lumbar spine bone mineral density (BMD), and trabecular bone score (TBS).
UNASSIGNED: Thirty-two patients (19 PAI, 18 female), median age 52 years (39.4-60.7), were included. At baseline, osteopenia was observed in 38% of patients and osteoporosis in 9%, while TBS was at least partially degraded in 41.4%. Higher body surface area-adjusted glucocorticoid doses predicted worse neck (P < .001) and total hip BMD (P < .001). Longitudinal analysis showed no significant change in BMD. TBS showed a trend toward decrease (P = .090). Bone markers were stable, albeit osteocalcin levels significantly varied. PAI and SAI subgroups behaved similarly, as did patients switching from hydrocortisone or cortisone acetate. Compared with men, women exhibited worse decline in TBS (P = .017) and a similar trend for neck BMD (P = .053).
UNASSIGNED: After 6 years of chronic DR-HC replacement, BMD and bone markers remained stable. TBS decline is more likely due to an age-related derangement of bone microarchitecture rather than a glucocorticoid effect. Our data confirm the safety of DR-HC replacement on bone health in both PAI and SAI patients.
UNASSIGNED: We evaluated the long-term effects of once-daily DR-HC on bone in PAI and SAI.
UNASSIGNED: Patients on immediate-release glucocorticoid therapy were evaluated before and up to 6 years (range, 4-6) after switching to equivalent doses of DR-HC, yielding data on bone turnover markers, femoral and lumbar spine bone mineral density (BMD), and trabecular bone score (TBS).
UNASSIGNED: Thirty-two patients (19 PAI, 18 female), median age 52 years (39.4-60.7), were included. At baseline, osteopenia was observed in 38% of patients and osteoporosis in 9%, while TBS was at least partially degraded in 41.4%. Higher body surface area-adjusted glucocorticoid doses predicted worse neck (P < .001) and total hip BMD (P < .001). Longitudinal analysis showed no significant change in BMD. TBS showed a trend toward decrease (P = .090). Bone markers were stable, albeit osteocalcin levels significantly varied. PAI and SAI subgroups behaved similarly, as did patients switching from hydrocortisone or cortisone acetate. Compared with men, women exhibited worse decline in TBS (P = .017) and a similar trend for neck BMD (P = .053).
UNASSIGNED: After 6 years of chronic DR-HC replacement, BMD and bone markers remained stable. TBS decline is more likely due to an age-related derangement of bone microarchitecture rather than a glucocorticoid effect. Our data confirm the safety of DR-HC replacement on bone health in both PAI and SAI patients.
摘要：
■原发性（PAI）和继发性肾上腺功能不全（SAI）患者出现骨代谢改变，可能是由于过度更换。双重释放氢化可的松（DR-HC）对几个参数显示出有希望的效果，但是很少研究骨骼代谢。
■我们评估了每日一次DR-HC对PAI和SAI骨骼的长期影响。
■接受速释糖皮质激素治疗的患者在6年之前进行了评估（范围，4-6）切换到等效剂量的DR-HC后，产生骨转换标记的数据，股骨和腰椎骨密度（BMD），和骨小梁评分（TBS）。
■32名患者（19名PAI，18名女性），中位年龄52岁（39.4-60.7），包括在内。在基线,在38%的患者中观察到骨质减少，在9%的患者中观察到骨质疏松，而TBS至少部分降解为41.4%。体表面积调整后的糖皮质激素剂量越高，颈部（P<.001）和髋部BMD（P<.001）越差。纵向分析显示BMD没有明显变化。TBS呈下降趋势(P=.090)。骨标记物稳定,尽管骨钙蛋白水平显着变化。PAI和SAI子组的行为类似，患者从氢化可的松或醋酸可的松转换也是如此。和男人相比,女性TBS下降更严重(P=0.017),颈部BMD下降趋势相似(P=0.053).
■经过6年的慢性DR-HC置换，BMD和骨标志物保持稳定。TBS下降更可能是由于与年龄相关的骨骼微结构紊乱，而不是糖皮质激素作用。我们的数据证实了DR-HC替代对PAI和SAI患者骨骼健康的安全性。
■我们评估了每日一次DR-HC对PAI和SAI骨骼的长期影响。
■接受速释糖皮质激素治疗的患者在6年之前进行了评估（范围，4-6）切换到等效剂量的DR-HC后，产生骨转换标记的数据，股骨和腰椎骨密度（BMD），和骨小梁评分（TBS）。
■32名患者（19名PAI，18名女性），中位年龄52岁（39.4-60.7），包括在内。在基线,在38%的患者中观察到骨质减少，在9%的患者中观察到骨质疏松，而TBS至少部分降解为41.4%。体表面积调整后的糖皮质激素剂量越高，颈部（P<.001）和髋部BMD（P<.001）越差。纵向分析显示BMD没有明显变化。TBS呈下降趋势(P=.090)。骨标记物稳定,尽管骨钙蛋白水平显着变化。PAI和SAI子组的行为类似，患者从氢化可的松或醋酸可的松转换也是如此。和男人相比,女性TBS下降更严重(P=0.017),颈部BMD下降趋势相似(P=0.053).
■经过6年的慢性DR-HC置换，BMD和骨标志物保持稳定。TBS下降更可能是由于与年龄相关的骨骼微结构紊乱，而不是糖皮质激素作用。我们的数据证实了DR-HC替代对PAI和SAI患者骨骼健康的安全性。
