Bone mineral density and body composition in children with congenital adrenal hyperplasia

Abstract

Background

Children with congenital adrenal hyperplasia (CAH) are exposed to fluctuating cortisol and androgen levels. The effects these hormonal states have on bone mineral density (BMD) and body composition are not well studied.

Objective

Compare BMD and body composition, including visceral adipose tissue (VAT) and Android:Gynoid (A:G) ratio, in children with CAH vs. healthy age-, sex-, and BMI-matched controls.

Methods

Forty-two cases with CAH (average age 12.3 years [SE 3]; 17 males) and 101 controls underwent a dual-energy X-ray absorptiometry scan. Total body BMD (TBMD) Z-scores were adjusted for height-for-age Z-scores (TBMD_HAZ). Hydrocortisone dose (mg/m²/day) was averaged over the past year. Bone age Z-scores were used as a surrogate for long-term androgen exposure in cases. Statistical analyses comparing cases and controls accounted for matched groups using mixed linear models.

Results

Children with CAH had lower TBMD (0.81 vs. 1.27, p=0.003) and TBMD_HAZ Z-scores (-0.51 vs. -0.01, p=0.001) than controls. In CAH cases, TBMD and TBMD_HAZ Z-scores were positively correlated with bone age Z-scores (respectively, r=0.63, p<0.0001; r=0.51, p=0.001) but were not associated with HC dose. VAT and the A:G ratio did not differ significantly between children with CAH and controls and neither was associated with HC dose.VAT was not associated with bone age Z-score.

Conclusion

Lower BMD was observed in CAH cases compared with controls though no differences in body composition were identified. Among CAH cases, increased chronic androgen exposure, as measured by bone age Z-scores, was associated with higher BMD but was not associated with VAT.

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