Bone mineral density and effects of growth hormone treatment in prepubertal children with Prader-Willi syndrome: a randomized controlled trial.
BACKGROUND
Bone mineral density (BMD) is unknown in children with Prader-Willi syndrome (PWS), but is decreased in adults with PWS. In patients with GH deficiency, BMD increases during GH treatment.


OBJECTIVE
The aim of the study was to evaluate BMD in children with PWS and to study the effects of GH treatment.


METHODS
We conducted a randomized controlled GH trial. Forty-six prepubertal children were randomized into either a GH-treated group (1.0 mg/m(2) . d) or a control group for 2 yr. At start, 6, 12, and 24 months of study, total body and lumbar spine BMD were measured by dual-energy x-ray absorptiometry, and lumbar spine bone mineral apparent density (BMAD) was calculated.


RESULTS
Baseline total body and lumbar spine BMD sd score (SDS) were normal [mean (sd), -0.2 SDS (1.1) and -0.4 SDS (1.2), respectively]. BMADSDS, which corrects for short stature, was also normal [mean (sd), 0.40 SDS (1.1)]. Total body BMDSDS decreased during the first 6 months of GH (P < 0.0001), but increased during the second year of treatment. After 24 months of study, total body and lumbar spine BMDSDS, and the BMADSDS did not significantly differ between GH-treated children and randomized controls (P = 0.30, P = 0.44, and P = 0.47, respectively). Results were similar when corrected for body mass index SDS. Repeated measurements analysis showed a significant positive association between IGF-I SDS and total body and lumbar spine BMDSDS, but not with BMADSDS.


CONCLUSIONS
Our results show that prepubertal children with PWS have a normal BMD. GH treatment had no effect on BMD, except for a temporary decrease of total body BMDSDS in the first 6 months.
de Lind van Wijngaarden
Roderick F A
RF
Dutch Growth Research Foundation, Erasmus University Medical Center/Sophia Children's Hospital, 3016 AH Rotterdam, The Netherlands. r.delindvanwijngaarden@erasmusmc.nl
Festen
Dederieke A M
DA
Otten
Barto J
BJ
van Mil
Edgar G A H
EG
Rotteveel
Joost
J
Odink
Roelof J
RJ
van Leeuwen
Mariëtte
M
Haring
Danny A J P
DA
Bocca
Gianni
G
Mieke Houdijk
E C A
EC
Hokken-Koelega
Anita C S
AC
D015502:Absorptiometry, Photon; D015519:Bone Density / Q000187:drug effects*; D002648:Child; D005260:Female; D019382:Human Growth Hormone / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008159:Lumbar Vertebrae / Q000378:metabolism; D008297:Male; D011218:Prader-Willi Syndrome / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D011627:Puberty; D016896:Treatment Outcome
D019382:Human Growth Hormone