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Original Article

Prednisolone impairs trabecular bone score changes in adolescents with 21-hydroxylase deficiency

Pattara Wiromrat¹  , Yutapong Raruenrom², Phanpaphorn Namphaisan¹, Nantaporn Wongsurawat², Ouyporn Panamonta¹, Chatlert Pongchaiyakul³

¹Division of Endocrinology, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
²Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
³Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Correspondence Pattara Wiromrat ,Email: patwiro@kku.ac.th

Received: July 16, 2024; Revised: August 27, 2024   Accepted: September 30, 2024.

Abstract

Background
Individuals with 21-hydroxylase deficiency (21OHD) require lifelong glucocorticoid (GC) therapy, which increases their risk of fragility fractures. However, fractures in GC-treated individuals can occur at normal bone mineral density (BMD) levels, suggesting an alteration in the bone microarchitecture.
Purpose
To evaluate trabecular bone microarchitecture and its changes in adolescents with 21OHD.
Methods
We enrolled 38 adolescents with 21OHD for whom complete clinical data and baseline and follow-up lumbar spine bone mineral density (LSBMD) measurements were available. The mean duration was 1.5 ± 0.6 years. Trabecular bone score (TBS), an indirect measurement of bone microarchitecture, was analyzed using iNsight™ software version 3.0. Impaired BMD and TBS were defined at Z-scores ≤ -1.5.
Results
At baseline, participants (55% female; 68% salt-wasting type; mean age, 15.2 ± 3.8 years; bone age, 17.5 ± 2.8 years; mean GC dose, 18.5 ± 6.5 mg/m2/day) had the prevalence of impaired BMD and TBS of 5% and 18%, respectively. During follow-up, adolescents with 21OHD receiving prednisolone showed a lower annual percentage change in TBS than those who received hydrocortisone (p = 0.028). A stepwise regression analysis showed that body mass index percentile (p < 0.001) and testosterone concentration (p = 0.002) were independent positive predictors of the baseline TBS Z-score, whereas prednisolone use was the only negative predictor of the annual percentage change in TBS (p = 0.002).
Conclusion
Adolescents with 21OHD have a high prevalence of impaired bone microarchitecture. Furthermore, prednisolone therapy is associated with impaired bone microarchitecture development, suggesting that hydrocortisone may better preserve bone microarchitecture and should be considered the first-line treatment for this population.

Keywords :Adolescents, 21-hydroxylase deficiency, Glucocorticoid, Trabecular bone score