A randomized trial found that patients with adrenal insufficiency had significant improvements in bone and metabolic markers when given low-dose once-daily steroids versus conventional treatment. The study included 46 participants. Conventional steroid treatment is associated with a decrease in bone mass density (BMD), especially in the lumbar spine, and an increased incidence of vertebral fractures. After 60 months of follow-up, there were significant increases in BMI (p=0.004), waist circumference (p=0.026), and vitamin D (p=0.005), as well as decreases in osteocalcin (p=0.002), bone alkaline phosphatase (p=0.024), and lumbar BMD T- and Z-scores (p<0.001 and p=0.001) in patients on conventional treatment. Compared to dual hydrocortisone release (DR-HC), patients on conventional treatment had higher waist circumference (p=0.045) and bone alkaline phosphatase (p<0.001), lower osteocalcin (p=0.001) and lower lumbar spine and femoral neck Z-scores (p=0.045 and p=0.047). DR-HC is associated with an improvement in BMD and no new fractures, in contrast to conventional treatment, where the decrease in BMD is related to the duration of the disease and a high daily dose of body surface steroids. A reduction in the daily dose of hydrocortisone leads to an increase in BMD in the lumbar spine and hip joint.[1][2][3][4]