Effect of long-term growth-hormone substitution therapy on bone mineral density and parameters of bone metabolism in adult patients with growth hormone deficiency.
Reduced bone mineral density (BMD) and the prevalence for osteoporotic vertebral fractures are symptoms of growth hormone deficiency (GHD) syndrome, and GH replacement therapy is now available for GH-deficient adults. We investigated the long-term effects of GH replacement therapy on bone mineral density (BMD) and bone metabolism in 19 adult patients with GHD over a period of 18 months. In response to GH treatment, the initially decreased IGF-I concentrations rose significantly during 18 months of therapy to levels within the normal range (matched for sex and age) (mean change 158.1 +/- 50.8 ng/ml, P < 0.001). Parameters of bone formation such as osteocalcin (OC) and procollagen I-C-Peptide (PICP) showed a significant increase in the first 6 months of therapy, followed by a slight decrease in the next months. Markers of bone resorption (CrosslapsR and deoxypyridinoline (D-Pyr) also increased significantly with a peak value after 6 months and all parameters except PICP remained above baseline values after 18 months. BMD of the femoral neck (FN) showed an increase after 18 months of therapy (mean change 0.01 +/- 0.03 g/cm2 after 18 months, n.s.). However, the increase in BMD was significant only in the lumbar spine (LS) (mean change 0.03 +/- 0.04 g/cm2, P < 0.05 after 18 months). We conclude that GH replacement therapy in adult patients with GHD over a period of 18 months causes a pronounced increase in bone turnover mainly during the first 12 months of therapy and increases BMD of the lumbar spine and the femoral neck after 18 months.
Kotzmann
H
H
Division of Endocrinology, Department of Medicine III, University of Vienna, Währinger Gürtel 18-20 A-1090 Vienna, Austria.
Riedl
M
M
Bernecker
P
P
Clodi
M
M
Kainberger
F
F
Kaider
A
A
Woloszczuk
W
W
Luger
A
A
D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood / Q000187:drug effects; D000596:Amino Acids / Q000187:drug effects / Q000652:urine; D015519:Bone Density / Q000187:drug effects*; D001846:Bone Development / Q000187:drug effects*; D001842:Bone and Bones / Q000187:drug effects* / Q000378:metabolism*; D003094:Collagen / Q000187:drug effects / Q000652:urine; D003404:Creatinine / Q000652:urine; D004311:Double-Blind Method; D005260:Female; D005272:Femur Neck / Q000187:drug effects; D006130:Growth Disorders / Q000188:drug therapy; D013006:Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000187:drug effects / Q000378:metabolism; D008159:Lumbar Vertebrae / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood / Q000187:drug effects; D010281:Parathyroid Hormone / Q000097:blood; D010446:Peptide Fragments / Q000097:blood / Q000187:drug effects; D011347:Procollagen / Q000097:blood / Q000187:drug effects; D013997:Time Factors; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
D000596:Amino Acids; D010281:Parathyroid Hormone; D010446:Peptide Fragments; D011347:Procollagen; C042813:procollagen type I carboxy terminal peptide; D015675:Osteocalcin; D014807:Vitamin D; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; C036020:deoxypyridinoline; D003094:Collagen; C104450:25-hydroxyvitamin D; D003404:Creatinine; D000469:Alkaline Phosphatase