Skeletal health in adult growth hormone deficiency

Recombinant growth hormone treatment, osteoporosis and fractures, more complicated than it seems!

“…A long-term (6-year) study [10] revealed a higher number of radiographic vertebral fractures in untreated compared with treated GHD patients, irrespective of age. Interestingly, in a large prospective database study of GHD patients [11], those with osteoporosis had similar fracture rates either with or without GH replacement, but GH replacement prevented fractures only for patients without osteoporosis at baseline.Despite BMD increase, the benefit of GH replacement on bone is not obvious in all GHD patients and an optimal GH dose to achieve the highest BMD increase remains unclear [8]; some studies suggest no correlation between GH dose and BMD change [9].Over the last decade, GH has been US Food and Drug Administration approved for other adult indications, in addition to GHD, including human immunodeficiency virus associated cachexia and short bowel syndrome. Therefore, given an exponentially increasing number of patients living with osteoporosis, there is renewed interest in GH use to treat age-related bone loss.…”

“…Fracture risk in patients with GHD is also high [8]; patients with hypopituitarism and GHD have a 2-5 times increased fracture risk, which is dependent on baseline disease and multiple hormonal replacements. Of note, BMD, as in other patients with pituitary tumors (acromegaly, for example) might not be a good predictor of fracture risk [9].…”

“…Despite BMD increase, the benefit of GH replacement on bone is not obvious in all GHD patients and an optimal GH dose to achieve the highest BMD increase remains unclear [8]; some studies suggest no correlation between GH dose and BMD change [9].…”