Long-term effects of growth hormone (GH) on bone mineral status and bone turnover markers in patients with isolated GH deficiency and multiple pituitary hormone deficiency
- 1 May 2007
- journal article
- Published by Wiley in Clinical Endocrinology
- Vol. 66 (5), 672-677
- https://doi.org/10.1111/j.1365-2265.2007.02799.x
Abstract
This study was designed to assess the long-term effects of growth hormone (GH) replacement therapy on bone mass and bone turnover markers in children with isolated GH deficiency (IGHD) and multiple pituitary hormone deficiency (MPHD). Fifty children (35 IGHD, 15 MPHD) receiving GH replacement therapy were enrolled in the study. The patients were followed for 38.6 +/- 15.7 months (1-5 years). Bone mineral density (BMD) of the lumbar region and bone turnover markers [PTH, osteocalcin, bone-specific alkaline phosphatase (boneALP), and the carboxyterminal propeptide of type-1 collagen (CPP-I)] were assessed annually. The height standard deviation score (SDS) of patients with IGHD and MPHD at diagnosis was statistically significant (P = 0.012), and the change in height SDS during 3 years (Deltaheight SDS(3 years)) was statistically similar between these two groups (P = 0.651). The BMD z-scores of the two groups were comparable at the start of GH therapy (P = 0.083), and then increased in both groups similarly during 5 years of GH replacement therapy (F = 0.349, P = 0.567). When the BMD z-scores during 5 years of GH therapy were analysed in the IGHD and MPHD groups separately, it was found that the BMD z-score increased significantly in IGHD (P < 0.001) but the increase was not significant in MPHD (P = 0.140). Multiple regression analysis showed that the change in BMD z-score during 3 years of GH therapy (DeltaBMD z-score(3 years)) was predicted by the BMD z-score and height SDS at the start of GH therapy and by Deltaheight SDS(3 years) in the IGHD group (t = -2.582, P = 0.02; t = 2.322, P = 0.034 and t = 2.908, P = 0.01, respectively). Age and BMD z-score and height SDS at diagnosis were found to have predictive values for the DeltaBMD z-score(3 years) (t = -3.652, P = 0.022; t = -4.073, P = 0.015 and t = 3.389, P = 0.028, respectively) in the MPHD group. The changes in boneALP, osteocalcin, CPP-1 and PTH levels during the therapy were statistically similar between the IGHD and MPHD groups. BMD increased during GH therapy in the IGHD and MPHD groups. GH had a positive effect on bone mass in the short as well as the long term. Early diagnosis and treatment could improve peak bone mass in patients with MPHD. The time and dose of sex steroids for pubertal induction and progression, which mimics physiological secretion, might also contribute to bone accretion in patients with MPHD.Keywords
This publication has 21 references indexed in Scilit:
- Responses of Bone Turnover Markers and Bone Mineral Density to Growth Hormone Therapy in Ghildren with Isolated Growth Hormone Deficiency and Multiple Pituitary Hormone DeficienciesJournal of Pediatric Endocrinology and Metabolism, 2002
- Bone Loss Is Correlated to the Severity of Growth Hormone Deficiency in Adult Patients with HypopituitarismJournal of Clinical Endocrinology & Metabolism, 1999
- Measurement of Volumetric Bone Mineral Density Accurately Determines Degree of Lumbar Undermineralization in Children with Growth Hormone DeficiencyJournal of Clinical Endocrinology & Metabolism, 1998
- Increase in Bone Density and Plasma Osteocalcin During Growth Hormone Therapy in Growth Hormone Deficient ChildrenJournal of Pediatric Endocrinology and Metabolism, 1997
- Consequences of childhood-onset growth hormone deficiency for adult bone massJournal of Bone and Mineral Research, 1994
- Reduced bone mineral density in patients with adult onset growth hormone deficiencyJournal of Clinical Endocrinology & Metabolism, 1994
- Effects of long-term treatment with growth hormone on bone and mineral metabolism in children with growth hormone deficiencyThe Journal of Pediatrics, 1993
- Bone mineral status in growth hormone deficiencyThe Journal of Pediatrics, 1980
- Variations in the Pattern of Pubertal Changes in BoysArchives of Disease in Childhood, 1970
- Variations in pattern of pubertal changes in girls.Archives of Disease in Childhood, 1969