Objective: 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. The study’s objective was to compare BMD and body composition, including visceral adipose tissue (VAT) and Android:Gynoid (A:G) ratio, in children with CAH vs healthy age-matched, sex-matched and BMI-matched controls. Design: Total body BMD (TBMD) Z-scores were adjusted for height-for-age Z-scores (TBMDHAZ). Hydrocortisone dose (mg/m2/d) 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. Patients: 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. Results: Children with CAH had lower TBMD (0.81 vs 1.27, P =.003) and TBMDHAZ Z-scores (−0.51 vs −0.01, P =.001) than controls. In CAH cases, TBMD and TBMDHAZ Z-scores were positively correlated with bone age Z-scores (r =.63, P <.0001; r =.51, P =.001, respectively) 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 although 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.
Bibliographical noteFunding Information:
Funding for this project was provided
Funding information Funding for this project was provided in part by the National Heart, Lung, and Blood Institute/NIH (R01HL110957), the National Center for Advancing Translational Sciences/NIH (UL1TR000114), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)/NIH NORC Grant Number P30 DK050456, and the Clinical and Translational Science Award/NIH (8UL1TR000114-02). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Not applicable.
© 2018 John Wiley & Sons Ltd
Copyright 2018 Elsevier B.V., All rights reserved.
- body composition
- bone mineral density
- congenital adrenal hyperplasia
- visceral adipose tissue