News from Addenbrooke's on DHEA and bone density

By:  Katherine White  Tuesday 2 December 2003

Dr Ellie Gurnell and Professor Krish Chatterjee have now completed the data analysis from the Addenbrooke's DHEA trials, including the bone density measurements, the psychological assessments of well-being and the baseline assessments of hydrocortisone and fludrocortisone replacement.  

They have presented their preliminary findings at several medical conferences and are writing the results up in a formal academic paper. This will be submitted for publication in an accredited medical journal. Once their paper has been accepted for publication, Dr Gurnell and Professor Chatterjee will be able to give the ADSHG a detailed report on their findings. In the meantime, they can pass on the following information from the bone density analysis they have conducted.

The 12-month clinical trials (which became 24 months for some follow-up participants) produced mixed results in terms of bone density. As reported in the first study, Addisonians are generally at increased risk of osteoporosis i.e. thin ‘brittle’ bones. It had been hoped that boosting adrenal androgen levels in Addisonians, through DHEA replacement, would give some protection against this. The results are not clear-cut, which was disappointing, as it had been hoped that a more definite picture would emerge.

Therefore their advice would be that Addisonian’s cannot rely on DHEA replacement alone to give them protection against the risks of osteoporosis. Anyone with adrenal insufficiency needs to follow the standard, commonsense preventative measures – both men and women.

Dr Gurnell says all Addisonian’s should consistently adopt the following “lifestyle” measures to optimize their bone density. These are to make sure their diet includes plenty of calcium (1g per day), Vitamin D (800U) and daily weight-bearing exercise.  This exercise can be as simple as a 20 minute walk each day. Obviously Addisonians should refrain from smoking.

She would also advise all ADSHG members to request a bone density scan from their GP or endocrinologist, at least once. Repeat scans can then be scheduled according to clinical need, which is likely to be around every 5 - 10 years if well. Women should ensure they have a bone density scan around the time of the menopause if they have not already done so. (Dr Gurnell reminds those who took part in the Addenbrooke’s 12 month trial that they have had a bone density scan done, with the results sent to their GP).

For anyone with low bone mass density, prescription medication which helps to rebuild bone mass is available. The most frequently used medications are called bisphosphonates: Fosamax is a well-known brand name.

Hormone Replacement Therapy (HRT) is also frequently used to treat low bone density in women. Given the recent ‘scares’, patients and doctors are now more cautious about taking or prescribing HRT.

Dr Gurnell would advise that for those Addisonian women who undergo a premature menopause, medical evidence to date would still recommend oestrogen replacement (the pill or HRT) until the average age of menopause is reached – age 55. Thereafter the risks and benefits of HRT need to be discussed on an individual basis with your GP or consultant.  As mentioned above, there are alternative medications available for bone protection.

Once again Dr Gurnell and Professor Chatterjee, on behalf of all the investigators, would like to thank the ADSHG for their participation and continued support.