{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T03:52:19Z","timestamp":1784605939663,"version":"3.55.0"},"reference-count":36,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2014,6,28]],"date-time":"2014-06-28T00:00:00Z","timestamp":1403913600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"National Institutes of Health Intramural Program"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2015,3]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Prior studies reveal that bone mineral density (<jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content>) in congenital adrenal hyperplasia (<jats:styled-content style=\"fixed-case\">CAH<\/jats:styled-content>) is mostly in the osteopaenic range and is associated with lifetime glucocorticoid dose. The forearm, a measure of cortical bone density, has not been evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We aimed to evaluate <jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content> at various sites, including the forearm, and the factors associated with low <jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content> in <jats:styled-content style=\"fixed-case\">CAH<\/jats:styled-content> patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eighty <jats:styled-content style=\"fixed-case\">CAH<\/jats:styled-content> adults (47 classic, 33 nonclassic) underwent dual\u2010energy\u2010x\u2010ray absorptiometry and laboratory and clinical evaluation. <jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content> Z\u2010scores at the <jats:styled-content style=\"fixed-case\">AP<\/jats:styled-content> spine, total hip, femoral neck, forearm and whole body were examined in relation to phenotype, body mass index, current glucocorticoid dose, average 5\u2010year glucocorticoid dose, vitamin D, 17\u2010hydroxyprogesterone, androstenedione, testosterone, dehydroepiandrosterone and dehydroepiandrosterone sulphate (<jats:styled-content style=\"fixed-case\">DHEAS<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Reduced <jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content> (T\u2010score &lt;\u22121 at hip, spine, or forearm) was present in 52% and was more common in classic than nonclassic patients (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a00<\/jats:italic>\u00b7005), with the greatest difference observed at the forearm (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a00<\/jats:italic>\u00b701). Patients with classic compared to nonclassic <jats:styled-content style=\"fixed-case\">CAH<\/jats:styled-content>, had higher 17\u2010hydroxyprogesterone (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a00<\/jats:italic>\u00b7005), lower <jats:styled-content style=\"fixed-case\">DHEAS<\/jats:styled-content> (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a00<\/jats:italic>\u00b70002) and higher non\u2010traumatic fracture rate (<jats:italic>P\u00a0=\u00a00<\/jats:italic>\u00b70005). In a multivariate analysis after adjusting for age, gender, height standard deviation, phenotype and cumulative glucocorticoid exposure, higher <jats:styled-content style=\"fixed-case\">DHEAS<\/jats:styled-content> was independently associated with higher <jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content> at the spine, radius and whole body.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Classic <jats:styled-content style=\"fixed-case\">CAH<\/jats:styled-content> patients have lower <jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content> than nonclassic patients, with the most affected area being the forearm. This first study of forearm <jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content> in <jats:styled-content style=\"fixed-case\">CAH<\/jats:styled-content> patients suggests that low <jats:styled-content style=\"fixed-case\">DHEAS<\/jats:styled-content> may be associated with weak cortical bone independent of glucocorticoid exposure.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.12507","type":"journal-article","created":{"date-parts":[[2014,5,24]],"date-time":"2014-05-24T16:12:38Z","timestamp":1400947958000},"page":"330-337","source":"Crossref","is-referenced-by-count":48,"title":["Cortical bone mineral density in patients with congenital adrenal hyperplasia due to 21\u2010hydroxylase deficiency"],"prefix":"10.1111","volume":"82","author":[{"given":"Diala","family":"El\u2010Maouche","sequence":"first","affiliation":[{"name":"National Institute of Dental and Craniofacial Research National Institutes of Health (NIH) Bethesda MD USA"},{"name":"National Institutes of Health (NIH) Clinical Center Bethesda MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Collier","sequence":"additional","affiliation":[{"name":"National Institutes of Health (NIH) Clinical Center Bethesda MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mala","family":"Prasad","sequence":"additional","affiliation":[{"name":"Radiology and Imaging Sciences Department Warren G. 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