ECE2023 Poster Presentations Adrenal and Cardiovascular Endocrinology (72 abstracts)
Bone metabolism and dual-release Hydrocortisone: results from a real-life study
Davide Ferrari 1 , Valentina Sada 1 , Valeria Hasenmajer 1 , Dario De Alcubierre 1 , Giulia Puliani 2 , Marianna Minnetti 1 , Alessia Cozzolino 1 , Ilaria Bonaventura 1 , Alessandra Tomaselli 1 , Riccardo Pofi 3 , Andrea Lenzi 1 & Andrea M. Isidori 1
1Sapienza University of Rome, Department of Experimental Medicine, Rome, Italy; 2Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Regina Elena National Cancer Institute, Oncological Endocrinology Unit, Rome, Italy; 3University of Oxford, Oxford Center for Diabetes, Endocrinology and Metabolism, Oxford, United Kingdom
Background: Patients with adrenal insufficiency (AI) require long-term glucocorticoid (GC) replacement therapy and generally show an increased prevalence of bone metabolism alterations. Only few data are available on bone safety of dual-release Hydrocortisone (DR-HC) therapy.
Objective: To evaluate bone metabolism in both primary AI (PAI) and secondary AI (SAI) during long-term therapy with DR-HC.
Methods: We studied patients with AI on short-acting, immediate-release GC therapy (hydrocortisone or cortisone acetate) before and up to 60 months after the switch to an equivalent dose of DR-HC, collecting data on bone turnover markers, femoral and lumbar spine areal bone mineral density (aBMD) and trabecular bone score (TBS). Any concomitant condition (hypo- or hyperparathyroidism, early menopause, malignancies) or medication (PTH, anti-resorptive therapy) that could influence bone parameters was considered as exclusionary.
Results: 31 patients (18 PAI and 13 SAI, 18 females, 9 post-menopausal) with a median age of 51 (range 20-77) years, were included. Patients on established immediate-release glucocorticoid therapy were switched to an equivalent dose of DR-HC at baseline. Median duration of AI at baseline was 36 months (range 12-432). Median daily hydrocortisone- equivalent doses before switching to DR-HC were 14.7 [12.0-17.3] mg/kg/m2 in PAI and 11.0 [10.1 – 13.2] mg/kg/m2 in SAI. Any other hormonal disorders (i.e. diabetes, hypothyroidism, hypogonadism, Growth Hormone deficiency) were adequately controlled throughout the study. All patients had normal calcium and phosphorus levels and most were under cholecalciferol therapy, with mean Vit D 30.0 ±13.2 ng/mL at baseline. At baseline, 48% of patients had aBMD values compatible with osteopenia and 16% had a diagnosis of osteoporosis in at least one site. Compared to baseline, no significant difference was observed in aBMD at femur neck, total hip and total lumbar spine at 24 (P= .825; P=.453; P=.637), 36 (P=.637; P=.460; P=.607), 48 (P=.202; P=.996; P=.379) and 60 months (P=.175; P=.528; P=.983) of DR-HC therapy. Interestingly, TBS values significantly decreased after 48 (P=.021) and 60 months (P=.032), although a physiological decline of bone microarchitecture with aging is expected. Alkaline phosphatase, C-terminal telopeptide and osteocalcin levels showed no differences in all timepoints. Moreover, no differences were found between PAI and SAI patients in all the evaluated parameters.
Conclusions: DR-HC is a safe treatment option in terms of bone health in patients with AI, maintaining stable bone mass, bone quality and bone turnover while aging.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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