Adrenal steroids and the development of osteoporosis in oophorectomised women

Abstract

To explore the possibility that the wide variation in bone loss among oophorectomised women might be due to differences in adrenal androgens or their biosynthetic pathways, 18 women (10 with very fast and 8 with very slow bone loss) were selected. Serum levels of nine adrenal steroids, including the major androgens and cortisol, were measured under basal conditions and after overnight suppression followed by acute corticotropin stimulation. In addition, basal serum oestrone, oestradiol, dehydroepiandrosterone sulphate, sex-hormone-binding-globulin, corticosteroid binding globulin, and urinary free cortisol were measured. The only significant differences found were that women who lost bone rapidly had significantly higher urinary free-cortisol excretion (p less than 0.001) and a paradoxically diminished cortisol response to corticotropin. These data make it unlikely that endogenous adrenal androgens or oestrogens are a major factor in preventing bone loss after cessation of ovarian function; cortisol by its catabolic effect, however, may be a significant factor in causing osteoporosis.

PIP: To examine the influence of differences in adrenal androgens or their biosynthetic pathways in the wide variations in bone loss among oophorectomized women, 18 women were selected for study. 10 women had very fast bone loss and 8 had very slow; 5 other women who had been on estrogen replacement therapy were also selected. Difference between the fast and slow losers in urinary free cortisol excretion was highly significant; the levels were higher in fast loser (P-.001). Treated patients had values similar to those of slow losers. No difference was detected between fast and slow losers in basal plasma values for dehydro-epiandrosterone (DHEA), adione, adiol, testosterone, DHEA-SO4, estrone, estradiol, cortisol, sex hormone binding globulin, and corticosteroid binding globulin. The only significant differences found were that women who lost bone rapidly had significantly higher free cortisol excretion and a paradoxically diminished cortisol response to corticotropin. It is, therefore, unlikely that endogenous adrenal androgens or estrogens are a major factor in preventing bone loss after cessation of ovarian function; however, cortisol, because of its catabolic effect may be a significant factor in causing osteoporesis. The serum levels of the 9 adrenal steroids were measured under basal conditions and after overnight suppression followed by acute corticotropin stimulation.