Ten-year GH replacement increases bone mineral density in hypopituitary patients with adult onset GH deficiency.
There are few studies that have determined the effects of long-term GH replacement on bone mineral density (BMD) in GH-deficient (GHD) adults. In this study, the effects of 10 years of GH replacement on BMD were assessed in 87 GHD adults using dual energy X-ray absorptiometry (DEXA). The results show that GH replacement induced a sustained increase in BMD at all the skeletal sites measured.


BACKGROUND
Little is known of the effect of more than 5 years of GH replacement therapy on bone metabolism in GHD adults.


METHODS
In this prospective, open-label, single-center study, which included 87 consecutive adults (52 men and 35 women; mean age of 44.1 (range 22-74) years) with adulthood onset GHD, the effect of 10 years of GH replacement on BMD was determined.


RESULTS
The mean initial dose of GH was 0.98 mg/day. The dose was gradually lowered and after 10 years the mean dose was 0.47 mg/day. The mean insulin-like growth factor-I (IGF-I) SDS increased from 1.81 at baseline to 1.29 at study end. The GH replacement induced a sustained increase in total, lumbar (L2-L4) and femur neck BMD, and bone mineral content (BMC) as measured by DEXA. The treatment response in IGF-I SDS was more marked in men, whereas women had a more marked increase in the total body BMC and the total body z-score. There was a tendency for women on estrogen treatment to have a larger increase in bone mass and density compared with women without estrogen replacement.


CONCLUSIONS
Ten years of GH replacement in hypopituitary adults induced a sustained, and in some variables even a progressive, increase in bone mass and bone density. The study results also suggest that adequate estrogen replacement is needed in order to have an optimal response in BMD in GHD women.
Götherström
G
G
Research Centre for Endocrinology and Metabolism, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45 Göteborg, Sweden. galina.götherström@medic.gu.se
Bengtsson
B-A
BA
Bosaeus
I
I
Johannsson
G
G
Svensson
J
J
D015502:Absorptiometry, Photon; D000328:Adult; D017668:Age of Onset; D000368:Aged; D015415:Biomarkers; D001827:Body Height / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D015519:Bone Density / Q000187:drug effects*; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging / Q000517:prevention & control; D015914:Estrogen Replacement Therapy; D005260:Female; D013006:Growth Hormone / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000172:deficiency*; D006801:Humans; D007018:Hypopituitarism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012727:Sex Characteristics
D015415:Biomarkers; D019382:Human Growth Hormone; D013006:Growth Hormone