Bone Mineral Density in Children with Congenital Adrenal Hyperplasia
Background: Treatment in all forms of Congenital Adrenal Hyperplasia (CAH) includes lifelong replacement of steroids. Steroids have an impact on bone health in multiple ways and are known to cause osteoporosis when given in high doses or for a longer duration. Objective: To evaluate bone mineral...
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| Format: | Article |
| Language: | English |
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Liaquat National Hospital and Medical College
2024-04-01
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| Series: | Liaquat National Journal of Primary Care |
| Subjects: | |
| Online Access: | https://journals.lnh.edu.pk/lnjpc/pdf/84ab7992-c410-4b2c-91b7-e00ddf7a002f.pdf |
| _version_ | 1797352421525028864 |
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| author | Karishma Mohsina Noor Ibrahim Versha Rani Rai Saima Batool Afridi Maria Riaz Taj Laghari |
| author_facet | Karishma Mohsina Noor Ibrahim Versha Rani Rai Saima Batool Afridi Maria Riaz Taj Laghari |
| author_sort | Karishma |
| collection | DOAJ |
| description | Background: Treatment in all forms of Congenital Adrenal Hyperplasia (CAH) includes lifelong replacement of steroids. Steroids
have an impact on bone health in multiple ways and are known to cause osteoporosis when given in high doses or for a longer
duration.
Objective: To evaluate bone mineral density (BMD), using dual-energy X-ray absorptiometry (DEXA) scan in children with CAH
taking long-term steroids presenting in the pediatric endocrinology ward of National Institute of Child Health, (NICH) Karachi, Pakistan.
Materials and Methods: This cross-sectional study was performed at the Department of Pediatric Endocrinology, National Institute
of Child Health, Karachi from October 2021 to July 2022. A total of 47 diagnosed cases of CAH taking steroids for more than 5 years
were enrolled. Assessment of BMD was done using a DEXA scan. Lumbar spine BMD was done and Z-score was modified for height
for age z-score. The dose of steroids and duration was calculated.
Results: Out of 47 patients, low BMD was observed in 8 (17.02%) patients. Individuals with low BMD had significantly higher median
duration, (p=0.017), dose (p=0.003), and median alkaline phosphate level (p=0.036),) but low median BMD value (p=0.009) and z
score (p<0.001) than normal BMD individuals. Although median bone age (p=0.009) was appropriate for chronologic age in low BMD
patients. A moderate negative significant correlation was observed between z score and age (rho=-0.319, p=0.029), z-score and
duration of steroid treatment (rho=-0.364, p=0.012), z score and alkaline phosphate (rho=-0.466, p=0.001), z score and bone age
(rho=-0.378, p=0.009).
Conclusion: Low BMD was observed in 17% of children on the DEXA scan. Moreover, these individuals had significantly higher
median average duration and dose of hydrocortisone.
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| first_indexed | 2024-03-08T13:15:18Z |
| format | Article |
| id | doaj.art-5f00c013467d45d49aa4c38859c2163d |
| institution | Directory Open Access Journal |
| issn | 2707-3521 2708-9134 |
| language | English |
| last_indexed | 2024-03-08T13:15:18Z |
| publishDate | 2024-04-01 |
| publisher | Liaquat National Hospital and Medical College |
| record_format | Article |
| series | Liaquat National Journal of Primary Care |
| spelling | doaj.art-5f00c013467d45d49aa4c38859c2163d2024-01-18T07:45:59ZengLiaquat National Hospital and Medical CollegeLiaquat National Journal of Primary Care2707-35212708-91342024-04-0161555910.37184/lnjpc.2707-3521.5.43Bone Mineral Density in Children with Congenital Adrenal HyperplasiaKarishma0Mohsina Noor Ibrahim1Versha Rani Rai2Saima Batool Afridi3Maria Riaz4Taj Laghari5National Institute of Child Health (NICH), Karachi, PakistanNational Institute of Child Health (NICH), Karachi, PakistanNational Institute of Child Health (NICH), Karachi, PakistanNational Institute of Child Health (NICH), Karachi, PakistanNational Institute of Child Health (NICH), Karachi, PakistanNational Institute of Child Health (NICH), Karachi, PakistanBackground: Treatment in all forms of Congenital Adrenal Hyperplasia (CAH) includes lifelong replacement of steroids. Steroids have an impact on bone health in multiple ways and are known to cause osteoporosis when given in high doses or for a longer duration. Objective: To evaluate bone mineral density (BMD), using dual-energy X-ray absorptiometry (DEXA) scan in children with CAH taking long-term steroids presenting in the pediatric endocrinology ward of National Institute of Child Health, (NICH) Karachi, Pakistan. Materials and Methods: This cross-sectional study was performed at the Department of Pediatric Endocrinology, National Institute of Child Health, Karachi from October 2021 to July 2022. A total of 47 diagnosed cases of CAH taking steroids for more than 5 years were enrolled. Assessment of BMD was done using a DEXA scan. Lumbar spine BMD was done and Z-score was modified for height for age z-score. The dose of steroids and duration was calculated. Results: Out of 47 patients, low BMD was observed in 8 (17.02%) patients. Individuals with low BMD had significantly higher median duration, (p=0.017), dose (p=0.003), and median alkaline phosphate level (p=0.036),) but low median BMD value (p=0.009) and z score (p<0.001) than normal BMD individuals. Although median bone age (p=0.009) was appropriate for chronologic age in low BMD patients. A moderate negative significant correlation was observed between z score and age (rho=-0.319, p=0.029), z-score and duration of steroid treatment (rho=-0.364, p=0.012), z score and alkaline phosphate (rho=-0.466, p=0.001), z score and bone age (rho=-0.378, p=0.009). Conclusion: Low BMD was observed in 17% of children on the DEXA scan. Moreover, these individuals had significantly higher median average duration and dose of hydrocortisone. https://journals.lnh.edu.pk/lnjpc/pdf/84ab7992-c410-4b2c-91b7-e00ddf7a002f.pdfbone mineral density (bmd)congenital adrenal hyperplasia (cah)dual energy x-ray absorptiometry (dexa) |
| spellingShingle | Karishma Mohsina Noor Ibrahim Versha Rani Rai Saima Batool Afridi Maria Riaz Taj Laghari Bone Mineral Density in Children with Congenital Adrenal Hyperplasia Liaquat National Journal of Primary Care bone mineral density (bmd) congenital adrenal hyperplasia (cah) dual energy x-ray absorptiometry (dexa) |
| title | Bone Mineral Density in Children with Congenital Adrenal Hyperplasia |
| title_full | Bone Mineral Density in Children with Congenital Adrenal Hyperplasia |
| title_fullStr | Bone Mineral Density in Children with Congenital Adrenal Hyperplasia |
| title_full_unstemmed | Bone Mineral Density in Children with Congenital Adrenal Hyperplasia |
| title_short | Bone Mineral Density in Children with Congenital Adrenal Hyperplasia |
| title_sort | bone mineral density in children with congenital adrenal hyperplasia |
| topic | bone mineral density (bmd) congenital adrenal hyperplasia (cah) dual energy x-ray absorptiometry (dexa) |
| url | https://journals.lnh.edu.pk/lnjpc/pdf/84ab7992-c410-4b2c-91b7-e00ddf7a002f.pdf |
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