Evaluation of glucocorticoid replacement therapy and of their effects on bone mineral density in Addison's disease

Assessment of patients on steroid replacement therapy is important to avoid the consequences of overtreatment such as osteoprosis. The aim of this pro spective study is to evaluate the severity and the etiology of osteopenia i n 24 patients (15 women, 9 men) with Addison's disease receiving 30 mg hydr ocortisone. Mean age of patients was 55 +/- 15 years. Osteoporosis, diagnosed by the measurement of bone mineral density (BMD) at the level of lumbar spine and right hip, was found in 58 % of patients, i. e; in 10 women and 4 men. The latter had normal testosterone levels while s even women had an early menopause, the etiology of their Addison's disease being autoimmune. Three were on hormonotherapy. Correlations were found bet ween BMD in the femoral neck and hip and the dose of hydrocortisone (mg/m(2 )/day; mg/kg/day), the duration of treatment and 24 hr-cortisoluria/g creat inine. Multivariate analysis shows that 24-hr cortisoluria/g creatinine is a good predictor of BMD values. Thus, osteoporosis is frequent in Addison's disease and cortisoluria could be a useful tool to predict this complicati on.