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
