Effect of long‐term treatment with GH on bone metabolism, bone mineral density and bone elasticity in GH‐deficient adults

Kann, Peter Herbert; Piepkorn, B.; Schehler, B; Andreas, J.; Lotz, Johannes; Prellwitz, W.; Beyer, Jeannette

doi:10.1046/j.1365-2265.1998.00439.x

Cited by 89 publications

(85 citation statements)

References 31 publications

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“…In the first months after GH therapy is begun, bone mineral resorption predominates over mineral disposition as more bone remodeling units are activated and the remodeling space is expanded, resulting in a net loss in BMD (48). This is subsequently reversed, leading to a progressive increment in BMD (6,7). The observations of an initial net loss in BMD in the present study are consistent with findings from other studies.…”

Section: Controlsupporting

confidence: 83%

“…Children with GH-deficiency (GHD) (1-3), as well as adult patients with childhood-onset or adult-onset GHD (1,2,(4)(5)(6)(7)(8), exhibit reduced bone mineral density (BMD) compared with healthy controls. Specifically, in young adults (!30 years of age) with childhood-onset GHD, significant reductions in cortical thickness, cortical cross-sectional area, and overall cortical content have been reported, which in association with the smaller bone size, result in a reduced BMD compared with age-and sex-matched healthy controls (1,2,8,9), placing these patients at increased risk of fracture (10).…”

Section: Introductionmentioning

confidence: 99%

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Treatment for 24 months with recombinant human GH has a beneficial effect on bone mineral density in young adults with childhood-onset GH deficiency

Conway

Szarras‐Czapnik

Rácz

et al. 2009

European Journal of Endocrinology

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Objective: Discontinuation of growth hormone (GH) therapy on completion of linear growth may adversely affect bone mineral density (BMD) in young adults with childhood-onset GH-deficiency (GHD). In the present study, we analyzed the impact of GH treatment on bone in young adults with GHD. Methods: BMD at the lumbar spine (L2-L4), total hip, and total body was measured at baseline and after 24 months in a cohort of young adults (18-25 years; nZ160) with severe GHD treated with GH during childhood who were randomized to GH (nZ109) or no treatment (nZ51) in a multicenter, multinational, open-label study. GH starting doses (0.2 mg/day (males), 0.4 mg/day (females)) were increased after 1 month to 0.6 mg/day (males) and 0.9 mg/day (females) and then to 1.0 mg/day (males) and 1.4 mg/day (females) at 3 months for the remainder of the study. Results: After 24 months, lumbar spine BMD had increased significantly more in GH-treated patients than in controls (6 vs 2%; estimated treatment difference; 3.5% (95% confidence interval, 1.52-5.51) P!0.001). GH also had a significant positive effect on total hip BMD (PZ0.015). Total body BMD was unchanged from baseline (PZ0.315). Conclusions: In young adults treated for childhood-onset GHD, there is a beneficial effect of continued GH treatment on BMD in adult life. Twenty-four months of GH treatment in these young adults was associated with an estimated 3.5% greater increase in BMD of the lumbar spine compared with controls.

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Section: Controlsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Treatment for 24 months with recombinant human GH has a beneficial effect on bone mineral density in young adults with childhood-onset GH deficiency

Conway

Szarras‐Czapnik

Rácz

et al. 2009

European Journal of Endocrinology

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“…The concomitant increase of both BGP and Dpd rule out a selective stimulation of bone formation as a potential factor responsible for the late anabolic effect of GH therapy on bone mass of adults with GHD (15)(16)(17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

GH replacement therapy increases plasma osteoprotegerin levels in GH-deficient adults

Lanzi¹,

Losa

Villa³

et al. 2003

European Journal of Endocrinology

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Objective: Osteoprotegerin (OPG), a glycoprotein belonging to the tumor necrosis factor receptor family, is an endogenous inhibitor of osteoclastogenesis produced by cells of the osteoblast lineage. OPG is a key cytokine involved in the regulation of osteoblast/osteoclast cross-talk. Since GH replacement therapy in GH deficiency (GHD) activates bone remodeling and increases bone mass, we investigated if short-term GH replacement therapy affects plasma OPG levels. Design and methods: Eighteen adults with GHD, ranging from 17 to 51 years (nine childhood-onset and nine adult-onset) were enrolled in the study. All subjects were on stable replacement therapy, especially sex hormones. The starting dose of GH replacement therapy was 4 mg/kg per day £ 7 days/week, and was progressively increased according to the serum IGF-I values. Biochemical parameters of bone and mineral metabolism were measured before and after 6 months of GH replacement therapy. Bone mass density (BMD) was monitored at three skeletal sites (lumbar vertebrae, femur, radius) by dual-energy X-ray absorptiometry. Results: After 6 months of therapy, ionized calcium, parathyroid hormone and 25-OH vitamin D did not change, whereas total serum calcium and urinary calcium excretion increased significantly ðP , 0:01Þ: Also osteocalcin and urinary deoxypyridinoline/24 h increased significantly (P , 0:02; P , 0:05 respectively). Mean basal T-scores of BMD values showed an osteopenic state, which remained unchanged after GH therapy. Plasma OPG increased significantly after 6 months of therapy ðP , 0:02Þ and this increase was significantly correlated with the increase of osteocalcin ðr ¼ 20:52; P ¼ 0:04Þ and deoxypyridinoline values ðr ¼ 20:64; P ¼ 0:011Þ: Conclusions: Our results suggest that the bone anabolic effect of GH replacement therapy could in part be mediated by a positive bone balance at each remodeling unit due to the inhibitory action of OPG on osteoclastogenesis.

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“…Estudos com uso de GH a longo prazo (pelo menos 18-24 meses) mostram aumento na DMO, mas ainda não se sabe se isso se traduz em uma redução no risco de fraturas (5,(49)(50)(51)(52)(53)(54). Encontramos aumento da DMO de coluna lombar e fêmur após 12 meses de reposição de GH (1,99±4,27% em coluna lombar e 2,55±4,30% no fêmur), que se manteve após 24 meses de tratamento (2,31±7,17% em coluna lombar e 5,33±9,64% no fêmur).…”

Section: Deficiência De Gh Em Adultos: Estudo Brasileirounclassified

Deficiência de GH em adultos: resultados do estudo multicêntrico brasileiro

Conceição

Boguszewski

Meister

et al. 2003

Arq Bras Endocrinol Metab

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RESUMOAvaliamos 70 pacientes com deficiência de GH, 39 mulheres e 31 homens, com idades entre 18 e 69 anos (média de 38,3±13,5), provenientes de 3 centros no Brasil. A dose de reposição variou entre os centros, bem como a resposta do IGF-1, que mostrou maior aumento nos centros com maior dose de GH. Reposição de GH levou a um aumento significativo nos níveis de IGF-1 e HDL colesterol, bem como da densidade mineral óssea (DMO), e a uma redução significativa nos níveis de colesterol total e LDL colesterol, semelhante nos 3 centros. Encontramos aumento mais significativo de HDL colesterol nas mulheres e aumento mais acentuado da DMO nos pacientes do sexo masculino. Concluimos que reposição de GH leva à melhora do perfil lipídico e da DMO, e que doses menores apresentam o mesmo benefício, provavelmente com menor incidência de efeitos colaterais. ABSTRACT GH Deficiency in Adults: Results of the Brazilian Multicenter Study.We have evaluated 70 patients with GH deficiency, 39 females and 31 males, ranging in age from 18 to 69 years (mean: 38.3±13.5), from 3 centers in Brazil. GH replacement dose was different among the centers, as well as IGF-1 response to GH, which was more pronounced in patients using the highest GH dose. GH replacement led to a significant increase of IGF-1 and HDL cholesterol, as well as bone mineral density (BMD) and to a significant decrease in total and LDL cholesterol that was similar among the centers. Female patients showed a more significant increase of HDL cholesterol, while men showed a more significant increase of BMD. In conclusion, GH replacement led to an improvement of lipid profile and BMD. Lower GH dose may lead to the same benefits, probably with a lower incidence of side effects.

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Effect of long‐term treatment with GH on bone metabolism, bone mineral density and bone elasticity in GH‐deficient adults

Cited by 89 publications

References 31 publications

Treatment for 24 months with recombinant human GH has a beneficial effect on bone mineral density in young adults with childhood-onset GH deficiency

Treatment for 24 months with recombinant human GH has a beneficial effect on bone mineral density in young adults with childhood-onset GH deficiency

GH replacement therapy increases plasma osteoprotegerin levels in GH-deficient adults

Deficiência de GH em adultos: resultados do estudo multicêntrico brasileiro

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