Spironolactone reduces biochemical markers of bone turnover in postmenopausal women with primary aldosteronism
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ORIGINAL ARTICLE
Spironolactone reduces biochemical markers of bone turnover in postmenopausal women with primary aldosteronism Christian Adolf1 Leah T. Braun1 Carmina T. Fuss2 Stefanie Hahner2 Heike Künzel1 Laura Handgriff1 Lisa Sturm1 Daniel A. Heinrich1 Holger Schneider1 Martin Bidlingmaier1 Martin Reincke1 ●
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Received: 24 March 2020 / Accepted: 9 May 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Context Primary aldosteronism (PA) is the most frequent form of endocrine hypertension. Besides its deleterious impact on cardiovascular target organ damage, PA is considered to cause osteoporosis. Patients and methods We assessed bone turnover in a subset of 36 postmenopausal women with PA. 18 patients had unilateral PA and were treated by adrenalectomy, whereas 18 patients had bilateral PA and received mineralocorticoid receptor antagonist (MRA) therapy respectively. 18 age- and BMI-matched females served as controls. To estimate bone remodeling, we measured the bone turnover markers intact procollagen 1 N-terminal propeptide, bone alkaline phosphatase, osteocalcin and tartrate resistant acid phosphatase 5b in plasma by chemiluminescent immunoassays at time of diagnosis and one year after initiation of treatment. Study design Observational longitudinal cohort study. Setting Tertiary care hospital. Results Compared with controls, patients with PA had mildly elevated osteocalcin at baseline (p = 0.013), while the other bone markers were comparable between both groups. There were no differences between the unilateral and the bilateral PA subgroup. One year after initiation of MRA treatment with spironolactone bone resorption and bone formation markers had significantly decreased in patients with bilateral PA. In contrast, patients adrenalectomized because of unilateral PA showed no significant change of bone turnover markers. Conclusion This study shows that aldosterone excess in postmenopausal women with PA is not associated with a relevant increase of bone turnover markers at baseline. However, we observed a significant decrease of bone markers in patients treated with spironolactone, but not in patients treated by adrenalectomy. Keywords Aldosterone Osteocalcin Osteoporosis Hyperparathyroidism Cortisol ●
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Introduction
Supplementary information The online version of this article (https:// doi.org/10.1007/s12020-020-02348-8) contains supplementary material, which is available to authorized users. * Martin Reincke [email protected] 1
Medizinische Klinik und Poliklinik IV, Klinikum der Universität, LMU München, Ziemssenstraße 1, 80336 Munich, Germany
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Medizinische Klinik und Poliklinik I, Schwerpunkt Endokrinologie und Diabetologie, Universitätsklinikum Würzburg, 97080 Würzburg, Germany
Primary aldosteronism (PA) represents the most common cause of endocrine arterial hypertension and affects about 5–10% of hypertensives [1, 2]. Moreover, PA has frequently been shown to induce target organ damage
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