Osteoporosis in Adrenal Insufficiency: Could Metformin be Protective?

Journal: Indian journal of clinical biochemistry : IJCB
Published Date: Sep 23, 2023

Abstract

Adrenal insufficiency (AI) is a serious disorder characterized by the adrenal glucocorticoid deficiency. Regardless of the etiology, AI patients need long-term replacement therapy for glucocorticoids and, in some cases, for mineralocorticoids. The replacement therapy cannot completely mirror the physiological secretion patterns, and therefore, glucocorticoid excess is a common sequela in AI patients. Moreover, due to the absence of the reliable clinical markers to monitor the adequacy of the replacement therapy, clinicians often over-treat the AI patients to avoid adrenal crisis. Long-term glucocorticoid use is associated with the loss of bone density and osteoporosis, increasing the risk of fractures. Moreover, glucocorticoid-induced hyperglycemia and type 2 diabetes mellitus further aggravates the bone disorders. In the recent years, ameliorating effects of metformin on glucocorticoid-induced bone disorders, as well as hyperglycemia, have been reported by a multitude of studies; and here, we reviewed and discussed the most recent findings regarding the positive effects of metformin on alleviating the bone disorders, and their implications in the AI patients.

Authors

  • Abduladheem Turki Jalil
    College of Medicine, University of Thi-Qar, Al-Nasiriyah, Thi-Qar, Iraq.
  • Mohanad Ali Abdulhadi
    Department of Medical Laboratory Techniques, Al-Maarif University College, Al-Anbar, Iraq.
  • Lubna R Al-Ameer
    College of Pharmacy, Al-Zahraa University for Women, Karbala, Iraq.
  • Zahraa Hamzaa Abd-Alzahraa
    National University of Science and Technology, Al-Nasiriyah, Thi-Qar, Iraq.
  • Muna S Merza
    Prosthetic Dental Techniques Department, Al-Mustaqbal University College, Hillah, Babylon, Iraq.
  • Rahman S Zabibah
    Medical Laboratory Technology Department, College of Medical Technology, The Islamic University of Najaf, Najaf, Iraq.
  • Hala Bahair
    Medical Technical College, Al-Farahidi University, Baghdad, Iraq.
  • Marghoob Hussein Yaas
    College of Nursing, Al-Kitab University, Kirkuk, Iraq.

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