Fracture incidence in GH-deficient patients on complete hormone replacement including GH.
Fracture risk in GHD patients is not definitely established. Studying fracture incidence in 832 patients on GH therapy and 2581 matched population controls, we recorded a doubled fracture risk in CO GHD women, but a significantly lower fracture risk in AO GHD men.


BACKGROUND
The objective of this study was to evaluate fracture incidence in patients with confirmed growth hormone deficiency (GHD) on replacement therapy (including growth hormone [GH]) compared with population controls, while also taking potential confounders and effect modifiers into account.


METHODS
Eight hundred thirty-two patients with GHD and 2581 matched population controls answered a questionnaire about fractures and other background information. Incidence rate ratio (IRR) and 95% CI for first fracture were estimated. The median time on GH therapy for childhood onset (CO) GHD men and women was 15 and 12 yr, respectively, and 6 and 5 yr for adult onset (AO) GHD men and women, respectively.


RESULTS
A more than doubled risk (IRR, 2.29; 95% CI, 1.23-4.28) for nonosteoporotic fractures was recorded in women with CO GHD, whereas no risk increase was observed among CO GHD men (IRR, 0.61) and AO GHD women (IRR, 1.08). A significantly decreased incidence of fractures (IRR, 0.54; 95% CI, 0.34-0.86) was recorded in AO GHD men.


CONCLUSIONS
Increased fracture risk in CO GHD women can most likely be explained by interaction between oral estrogen and the GH-IGF-I axis. The adequate substitution rate of testosterone (90%) and GH (94%) may have resulted in significantly lower fracture risk in AO GHD men.
Holmer
Helene
H
Department of Internal Medicine, Centralsjukhuset, Kristianstad, Sweden.
Svensson
Johan
J
Rylander
Lars
L
Johannsson
Gudmundur
G
Rosén
Thord
T
Bengtsson
Bengt-Ake
BA
Thorén
Marja
M
Höybye
Charlotte
C
Degerblad
Marie
M
Bramnert
Margareta
M
Hägg
Erik
E
Engström
Britt Edén
BE
Ekman
Bertil
B
Thorngren
Karl-Göran
KG
Hagmar
Lars
L
Erfurth
Eva-Marie
EM
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy* / Q000453:epidemiology; D015994:Incidence; D008297:Male; D012307:Risk Factors; D012737:Sex Factors; D013548:Sweden; D013739:Testosterone / Q000627:therapeutic use*
D019382:Human Growth Hormone; D013739:Testosterone