Predictors of bone responsiveness to growth hormone (GH) replacement in adult GH-deficient patients.
Growth hormone (GH) replacement in adulthood results in variable bone responses as a function of the gonadic hormonal milieu. We performed a retrospective analysis of a large cohort of adult males and females with confirmed GH deficiency (GHD) prior to treatment and during 3 years of replacement therapy. Potential confounders and effect modifiers were taken into account. Sixty-four adult patients with GHD (20 females and 44 males; mean age 34 years, range 18-64) were included in the analysis. GH replacement induced a different effect on bone in males compared to females. Bone mineral content increased in males and decreased in females at the lumbar spine, total femur, and femoral neck; bone mineral density showed a similar trend at the lumbar spine and femoral neck. There was no significant gender difference in bone area at any measured bone site. In both sexes we observed a similar trend for serum markers of bone remodeling. Sex predicted bone outcome on multivariate analysis, as did age, onset of GHD (childhood/adulthood), pretreatment bone mass, baseline body mass index (BMI), and BMI change during GH replacement. Serum IGF-I levels during treatment did not show any relationship with bone outcome at any measured site. This study confirms that bone responsiveness to GH replacement in adult GHD varies as a function of sex even after controlling for potential confounders and highlights the importance of other cofactors that may affect the interaction between GH replacement therapy and bone remodeling.
Endocrinology Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Alessandro
A
Rossini
Roberto
R
Lanzi
Marco
M
Losa
Marcella
M
Sirtori
Elisa
E
Gatti
Sara
S
Madaschi
Chiara
C
Molinari
Isabella
I
Villa
Marina
M
Scavini
Alessandro
A
Rubinacci
D015502:Absorptiometry, Photon / Q000379:methods; D000293:Adolescent; D000328:Adult; D001823:Body Composition; D015992:Body Mass Index; D016723:Bone Remodeling; D001842:Bone and Bones / Q000378:metabolism / Q000502:physiology; D005260:Female; D020249:Hormone Replacement Therapy / Q000379:methods*; D019382:Human Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012737:Sex Factors
D019382:Human Growth Hormone