SUN-445 Osteoporotic Fracture Risk in Men with Secondary/Tertiary Adrenal Insufficiency at an Urban Academic Medical Center

Abstract Disclosure: V. Rao: None. J. Turella: None. A.D. Rao: None. Introduction: Secondary/tertiary adrenal insufficiency (AI) is a relatively rare condition that affects approximately 300 individuals per million worldwide. Although treatment with steroid replacement is well established, complications of treatment, especially with regards to bone health, are less clear. Men are an under diagnosed and under treated population with regards to osteoporosis. Few studies have examined bone health in men with AI. Methods: We utilized a retrospective case control study design to compare osteoporosis and fracture risk in men with and without secondary/tertiary AI who were seen at Temple University Hospital between January 1, 2014-December 31, 2023. We included men age >=50 with an ICD-10 diagnosis of secondary or tertiary AI who were receiving steroid replacement therapy as cases. Controls were derived from the same population and included men who were incorrectly coded as AI, i.e. men age >=50 without laboratory evidence of AI and without steroid replacement or long-term steroid treatment. We excluded individuals >89 and with an ICD-10 diagnosis of any cancer, primary adrenal insufficiency, or other disorders established to have high risk of secondary osteoporosis. Comparisons between groups were performed with Fisher’s exact test, unpaired t-test, and linear regression. Results: In total, our study included 28 men with AI (46.4% secondary to steroids) and 33 men without AI. We found that 39.3% of men with AI had an osteoporotic fracture, which was significantly higher than men without AI (p=0.0185). Using body surface area to determine the appropriate hydrocortisone replacement dose (BSA*14.7), 39.3% of men received higher doses than recommended. Although those who received excess steroids had a higher osteoporotic fracture rate, it was not significant (p=0.0527). Further, 46.4% of men with AI had evidence of osteoporosis, of which 30.8% were prescribed an anti-resorptive or anabolic agent, 61.5% calcium, and 100% vitamin D. DEXA scans were ordered in less than half of men with AI. Conclusions: These data indicate that the high osteoporotic fracture rate in men with AI, who do not have confounding secondary risk factors, is likely related to over treatment. They also highlight the need for preemptive screening and possibly treatment to prevent fractures. Presentation: Sunday, July 13, 2025