Fifteen years of GH replacement increases bone mineral density in hypopituitary patients with adult-onset GH deficiency.
OBJECTIVE
Few studies have determined the effects of more than 5-10 years of GH replacement in adults on bone mineral content (BMC) and bone mineral density (BMD).


METHODS
In this prospective, single-centre, open-label study, the effects of 15 years of GH replacement on BMC and BMD, measured using dual-energy X-ray absorptiometry, were determined in 126 hypopituitary adults (72 men) with adult-onset GH deficiency (GHD). Mean age was 49.4 (range 22-74) years at the initiation of the study.


RESULTS
The mean initial GH dose of 0.63 (s.e.m. 0.03) mg/day was gradually lowered to 0.41 (0.01) mg/day after 15 years. The mean serum IGF1 SDS increased from -1.69 (0.11) at baseline to 0.63 (0.16) at the study end (P<0.001 vs baseline). The 15 years of GH replacement induced a sustained increase in total body BMC (+5%, P<0.001) and BMD (+2%, P<0.001). Lumbar (L2-L4) spine BMC increased by 9% (P<0.001) and BMD by 5% (P<0.001). In femur neck, a peak increase in BMC and BMD of 7 and 3%, respectively, was observed after 7 years (both P<0.001). After 15 years, femur neck BMC was 5% above the baseline value (P<0.01), whereas femur neck BMD had returned to the baseline level. In most variables, men had a more marked response to GH replacement than women.


CONCLUSIONS
Fifteen-year GH replacement in GHD adults induced a sustained increase in total body and lumbar (L2-L4) spine BMC and BMD. In femur neck, BMC and BMD peaked at 7 years and then decreased towards baseline values.
Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gröna Stråket 8, SE-413 45 Göteborg, Sweden. mariam.elbornsson@medic.gu.se
Mariam
M
Elbornsson
Galina
G
Götherström
Ingvar
I
Bosæus
Bengt-Åke
BÅ
Bengtsson
Gudmundur
G
Johannsson
Johan
J
Svensson
D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D000367:Age Factors; D000368:Aged; D015519:Bone Density / Q000187:drug effects / Q000502:physiology*; D005260:Female; D020249:Hormone Replacement Therapy / Q000379:methods*; D019382:Human Growth Hormone / Q000172:deficiency* / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007018:Hypopituitarism / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult
D019382:Human Growth Hormone