Increased prevalence of radiological spinal deformities in adult patients with GH deficiency: influence of GH replacement therapy.
This cross-sectional study shows that a high number of untreated adult patients with GHD develop radiological vertebral deformities. Patients undergoing GH replacement treatment showed a significantly lower prevalence of vertebral deformities versus treated patients in the presence of similar BMD, as assessed by DXA.


BACKGROUND
In this cross-sectional study, we investigated whether the prevalence and degree of spinal deformities in adults with growth hormone deficiency (GHD) were related to the age of patients, degree of bone turnover, BMD, and recombinant human GH (rhGH) replacement therapy.


METHODS
One hundred seven adult hypopituitary patients (67 males and 40 females; mean age, 47 years; range: 16-81 years) with severe GHD and 130 control subjects (39 males, 91 females; mean age: 58.9 years; range: 26-82 years) were evaluated for BMD (DXA) and vertebral deformities (quantitative morphometric analysis). At study entry, 65 patients were on replacement therapy with rhGH, whereas 42 patients had never undergone rhGH.


RESULTS
Vertebral fractures were significantly more frequent in GHD patients versus control subjects (63.6% versus 37.7%; chi2 15.7; p < 0.001). The fracture prevalence, as well as the fracture number, was significantly higher in untreated versus treated patients (78.6% versus 53.8%; chi2: 6.7; p = 0.009), although the two groups of patients did not show any significant difference in median T score. In untreated GHD patients, the prevalence of vertebral deformities was correlated with T score (p = 0.002) and duration of disease (p = 0.003). In treated GHD patients, the prevalence of spinal deformities was correlated only with the timing of the beginning of rhGH replacement.


CONCLUSIONS
This cross-sectional study reports high prevalence of vertebral radiological deformities in adult patients with untreated GHD. The replacement treatment of GHD leads to a significant decrease in fracture rate.
Mazziotti
Gherardo
G
Endocrine Section, Department of Internal Medicine, University of Brescia, Brescia, Italy.
Bianchi
Antonio
A
Bonadonna
Stefania
S
Nuzzo
Monica
M
Cimino
Vincenzo
V
Fusco
Alessandra
A
De Marinis
Laura
L
Giustina
Andrea
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000172:deficiency* / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011859:Radiography; D012307:Risk Factors; D013131:Spine / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000187:drug effects*
D019382:Human Growth Hormone