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Open Access 01-09-2020 | Spironolactone | Original Article

Spironolactone reduces biochemical markers of bone turnover in postmenopausal women with primary aldosteronism

Authors: Christian Adolf, Leah T. Braun, Carmina T. Fuss, Stefanie Hahner, Heike Künzel, Laura Handgriff, Lisa Sturm, Daniel A. Heinrich, Holger Schneider, Martin Bidlingmaier, Martin Reincke

Published in: Endocrine | Issue 3/2020

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.

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Title: Spironolactone reduces biochemical markers of bone turnover in postmenopausal women with primary aldosteronism
Authors: Christian Adolf
Leah T. Braun
Carmina T. Fuss
Stefanie Hahner
Heike Künzel
Laura Handgriff
Lisa Sturm
Daniel A. Heinrich
Holger Schneider
Martin Bidlingmaier
Martin Reincke
Publication date: 01-09-2020
Publisher: Springer US
Keywords: Spironolactone
Hyperparathyroidism
Osteoporosis
Osteoporosis
Published in: Endocrine / Issue 3/2020
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-020-02348-8

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