The association between idiopathic scoliosis and growth hormone treatment in short children

Park, Mijin; Kim, Yu Jin; Oh, Kyung Eun; Kang, Eungu; Nam, Hyo-Kyoung; Rhie, Young Jun; Lee, Kee-Hyoung

doi:10.6065/apem.2142186.093

“…The association between GH and scoliosis remains unclear. [25][26][27][28][29][30][31] Further understanding of this issue may be achieved by demonstrating the characteristics of scoliosis among the 3 types of short stature that have different GH concentrations and exploring the role of rhGH on scoliosis. Our results showed that no differences were observed in the prevalence of scoliosis and the incidence of scoliosis development and progression among the three types of short stature.…”

Section: Discussionmentioning

confidence: 99%

“…The association between GH and scoliosis remains unclear 25–31 . Further understanding of this issue may be achieved by demonstrating the characteristics of scoliosis among the 3 types of short stature that have different GH concentrations and exploring the role of rhGH on scoliosis.…”

Section: Discussionmentioning

confidence: 99%

Beyond growth hormone: association of short stature types and growth hormone with scoliosis

Hong,

Hu,

Xu

et al. 2023

Spine

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Study Design: Cross-sectional and retrospective cohort study. Objective: We investigated the effect of three types of short stature (partial growth hormone deficiency [GHD], GHD, and idiopathic short stature [ISS]) and recombinant human growth hormone (rhGH) therapy on scoliosis. Summary of Background Data: In short stature, rhGH is widely used and the concentration of growth hormone varies among types. The epidemiologic characteristics of scoliosis and the role of rhGH on scoliosis remain unclear. Methods: A cross-sectional study was conducted among 3896 patients with short stature (partial GHD, GHD, and ISS), and a 1:1 age- and sex-matched control group with preexisting whole-spine radiographs. The cohort study included 2605 subjects who underwent radiography more than twice to assess scoliosis development, progression, and the need for bracing and surgery. Adjusted logistic regression were used to assess differences in the prevalence of scoliosis among patients with partial GHD, GHD, ISS, and controls. The Kaplan-Meier method was used to analyze the time course of scoliosis development and progression. Cox regression was applied to assess the independent factors related to scoliosis development and progression. Mendelian randomization analyses were also performed. Results: Compared with controls, patients with short stature had a higher incidence of scoliosis (34.47% in partial GHD, 31.85% in GHD, 32.94% in ISS vs 8.83% in control, P <0.001), a higher risk of scoliosis development (HR=1.964 in partial GHD, P <0.001; HR=1.881 in GHD, P =0.001; HR=1.706 in ISS, P =0.001), but not a higher risk of progression, brace, or surgery. Among three types of short stature, there was no differences in the incidence, development and progression of scoliosis or the need for bracing or surgery. RhGH treatment increased the risk of scoliosis development in each short stature group (HR=2.673 in partial GHD, P<0.001; HR=1.924 in GHD, P=0.049; HR=1.564 in ISS, P=0.004). Vitamin D supplementation was protective against scoliosis development (HR=0.456 in partial GHD, P =0.003; HR=0.42 in GHD, P =0.013; HR=0.838 in ISS, P =0.257). Conclusions: More attention should be paid to the spinal curve in patients with partial GHD, GHD or ISS. For short stature treated with rhGH, the risk of scoliosis development was increased. Vitamin D supplementation may be beneficial for prevention. Level of evidence: 3.

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“…Histomorphological studies showed that compared with unaffected individuals, bone volume fraction, trabecular bone thickness, and bone cell and osteoblast density were decreased in AIS patients. 7 In addition, studies have found that the risk of developing idiopathic scoliosis is significantly correlated with the duration of rapid linear bone growth, especially with the peak rate of spinal growth. [8][9][10][11] Secondly, the ability of bone growth and development is represented by bone maturity.…”

Section: Scoliosismentioning

confidence: 99%

“…The decrease in bone density caused by hormone‐related abnormalities may be one of the core contents of the pathogenesis of AIS. Histomorphological studies showed that compared with unaffected individuals, bone volume fraction, trabecular bone thickness, and bone cell and osteoblast density were decreased in AIS patients 7 . In addition, studies have found that the risk of developing idiopathic scoliosis is significantly correlated with the duration of rapid linear bone growth, especially with the peak rate of spinal growth 8–11 .…”

Section: Scoliosismentioning

confidence: 99%

Impact of growth hormone on scoliosis

Zhang,

Li,

Shi

et al. 2023

Pediatric Discovery

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Growth hormone (GH) therapy has been used in patients with growth retardation and short stature due to various reasons. The safety of GH treatment is still debatable, one of which is the occurrence and development of scoliosis. In order to explore the effects of GH on the occurrence or progression of scoliosis, this review summarizes previous studies, summarizes the influence of GH treatment on the pathogenesis and progression of scoliosis, and analyzes the possible mechanism of GH in the pathogenesis and progression of scoliosis. Hopefully, it can provide a direction for future research.

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“…One study suggested that about 4% of children with ISS who received rhGH therapy developed scoliosis, and this incidence was concordant with that of a general population without rhGH treatment [ 8 ]. A study by Park et al [ 9 ] also reported that rhGH therapy was not associated with development or aggravation of idiopathic scoliosis, with no significant differences in average Cobb angle (6.2° vs. 6.1°, P =0.842) or prevalence of scoliosis (9.7% vs. 13.3%, P =0.481) before and after one year of GH treatment in 113 subjects who were diagnosed with GHD, SGA, or ISS.…”

mentioning

confidence: 97%

Commentary on "The association between idiopathic scoliosis and growth hormone treatment in short children"

Shim

¹

2022

Ann Pediatr Endocrinol Metab

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The first recombinant human growth hormone (rhGH) was approved for the treatment of growth hormone deficiency (GHD) in by the Food and Drug Administration of the United States of America in 1985. It has been approved for use in several growth disorders including GHD, Turner syndrome, chronic renal failure, small for gestational age (SGA), Prader-Willi syndrome, Noonan syndrome, SHOX deficiency, idiopathic short stature (ISS), achondroplasia, short bowel syndrome and human immunodeficiency virus wasting syndrome. 1) Although rhGH therapy is well established to be safe and tolerable, some concerns about adverse effects remain.Idiopathic scoliosis, which is defined as the development of spinal curvature of a minimum of 10°, is the most common type of scoliosis, affecting 2%-4% of children and adolescents, mainly those between 10 and 18 years of age. 2) In the general population, idiopathic scoliosis has been suggested to have both congenital and developmental components including genetic factors, estrogen, melatonin, diet, and exercise. 3) The velocity of spinal growth is a welldocumented risk factor for idiopathic scoliosis. 4) Because the onset and progression of scoliosis are closely associated with growth spurts, scoliosis inevitably remains an issue during rhGH treatment. A few studies have demonstrated the link between rhGH treatment and scoliosis. The first report of growth hormone in relation to scoliosis progression described a Swedish male case in 1978. 5) Wang et al. 6) suggested that growth hormone may increase the risk of progression of scoliosis based on a study of 250 children being treated with growth hormone.A recent study demonstrated that Cobb angle increased by 1.0° (P<0.001) per year in a rhGH patient group, whereas there was no significant annual change in the control group (P=0.496). 7) However, most studies regarding the potential relationship between rhGH treatment and scoliosis development or progression were conducted in a small sample, [5][6][7] and the impact of GH treatment on scoliosis remains controversial. Other studies indicated that the potential risk for scoliosis development during rhGH treatment is caused by rapid growth velocity rather than a direct effect of rhGH. One study suggested that about 4% of children with ISS who received rhGH therapy developed scoliosis, and this incidence was concordant with that of a general population without rhGH treatment. 8) A study by Park et al. 9) also reported that rhGH therapy was not associated with development or aggravation of idiopathic scoliosis, with no significant differences in average Cobb angle (6.2° vs. 6.1°, P=0.842) or prevalence of scoliosis (9.7% vs. 13.3%, P=0.481) before and after one year of GH treatment in 113 subjects who were diagnosed with GHD, SGA, or ISS.Recently, rhGH treatment is being attempted at a younger age and corresponding skeletal immaturity. It is notable that skeletal immaturity is one of the risk factors associated with scoliosis progression. 10) Therefore, such patients are at high risk for development...

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The association between idiopathic scoliosis and growth hormone treatment in short children

Cited by 6 publications

References 43 publications

Beyond growth hormone: association of short stature types and growth hormone with scoliosis

Beyond growth hormone: association of short stature types and growth hormone with scoliosis

Impact of growth hormone on scoliosis

Commentary on "The association between idiopathic scoliosis and growth hormone treatment in short children"

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