الفهرس 
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Abstract
It is interesting to study the BMD of patients with CAH in whom two major factors are in operation, glucocorticoids that can cause a reduction in bone mineral density (BMD), and on the other hand, adrenal androgens which are important in achieving and preserving peak bone mass. This study aimed to: 1. Evaluate bone mineral status in children and adolescents with congenital adrenal hyperplasia (21-hydroxylase defeciency) through evaluation of BMD, BMD Z-score of total body and lumbar spine by DXA taking into account the chronological age (CA) and height age (HA) at the time of the measurement to assess the discrepancy between chronological age (CA) and height age (HA) that can interfere with BMD measurement by DXA and in addition to evaluation of markers of bone metabolism including serum levels of calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), and Sclerostin. 2. Explore possible differences in bone mineral status parameters in CAH patieشnt sub groups (Salt wasting-group vs Simple virilizing-group), (Well controlled-group vs Poor controlled-group) and the total dialy does of hydrocortisone (>20 mg/m2/day vs ≤20 mg/m2/day). The result of the current study showed that there were significant higher height and height age values in SV group compared to SW group and Control group due to the positive effect of excess androgens and in turn excess estrogens in CAH patient that accelerating growth rate. There were significantly higher TB-BMD, L1-L4 BMD, Legs-BMD, Trunk- BMD in SW and SV group compared to control group that again reflect the positive effect of excess androgens and in turn excess estrogens that affect bone metabolism in CAH patient. We found that among total 40 CAH patients,12 patients had low BMD, they were distributed as 7 patients within SW-group and 5 patients within SV-group. There were significantly higher height, height age, weight, BMI, TB- BMD-Z.Score-H.A, L1-L4 BMD in CAH-receiving glucocorticoids at average totaly dialy does ≤ 20 mg/m2/day compared to those receiving <20 mg//m2/day. Regarding to serum sclerostin there were significantly higher serum sclerostin level in SW and SV group compared to control group. We also observed significantly lower serum calcium in SW and SV group compared to Control group, and significantly lower serum alkaline phosphatase in SW group compared to SV group and Control group. The analysis of sclerostin diagnostic value by Receiver operating characteristic curve (ROC), the results showed poor AUC (AUC=0.604 for total BMD) and (AUC=0.691 for L1-L4 BMD) indicate that sclerostin is poor predictor for low BMD in CAH patients and reflect the complex nature of CAH disease with multiple inter-related risk factors controlling BMD in these patients including BMI, steroid type, duration of steroid administration, does of glucocorticoid, and adrenal androgen.