title: Impact of the growth hormone replacement on bone status in growth hormone deficient adults.
abstract: BACKGROUND
  Growth hormone deficiency (GHD) is associated with reduced bone mineral density (BMD). GH replacement has positive effect on BMD but the magnitude of this effect and its mechanism are debated.
  
  
  OBJECTIVE
  The objectives of this study was first, to assess the effect of GH replacement on BMD, and second, to evaluate the effect of GH treatment on bone turnover and microarchitecture and to assess the factors influencing the effect of the therapy on BMD.
  
  
  METHODS
  Adult GHD (AO-GHD) and childhood onset GHD (CO-GHD) patients treated with GH using IGF-I normalization GH replacement regimen were prospectively followed during 2 years. Lumbar spine (L1-L4) and total femur BMD by Hologic discovery, in the subset of patients also bone turnover markers; osteocalcin and carboxy-terminal collagen crosslinks (CTx) were assessed at baseline and at months 3, 6, 12 and 24, respectively. The trabecular bone score (TBS) derived from lumbar spine DXA by the iNsight® software was assessed in a subset of study population at baseline and months 12 and 24.
  
  
  RESULTS
  In total, 147 GHD patients (age 35.1 years, 84 males/63 females, 43 of childhood onset GHD/104 AO-GHD) were included. BMD of lumbar spine and femur increased significantly during the treatment (14% and 7% increase at 2 years, respectively; p<0.0001). Bone markers increased during the first 12 months of treatment with subsequent decrease of CTx. At month 24, significant increase in TBS was observed (4%, p=0.02). BMD increase was significantly higher in males (15% increase in males vs. 10% in females, p=0.037) and childhood onset GHD (CO-GHD) patients (13% increase in CO-GHD, p=0.004).
  
  
  CONCLUSIONS
  GH supplementation leads to an increase of BMD with corresponding changes in bone turnover markers and changes in microarchitecture as assessed by trabecular bone score. Positive effect of GH on bone status is more pronounced in males and CO-GHD adults.
authors.affiliation: 5th Department of Internal Medicine, Medical Faculty of Comenius University, University Hospital, Bratislava, Slovakia.
authors.forename: M
authors.initials: M
authors.lastname: Kužma
authors.affiliation: 5th Department of Internal Medicine, Medical Faculty of Comenius University, University Hospital, Bratislava, Slovakia.
authors.forename: Z
authors.initials: Z
authors.lastname: Kužmová
authors.affiliation: 5th Department of Internal Medicine, Medical Faculty of Comenius University, University Hospital, Bratislava, Slovakia.
authors.forename: Z
authors.initials: Z
authors.lastname: Zelinková
authors.affiliation: 5th Department of Internal Medicine, Medical Faculty of Comenius University, University Hospital, Bratislava, Slovakia.
authors.forename: Z
authors.initials: Z
authors.lastname: Killinger
authors.affiliation: National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia.
authors.forename: P
authors.initials: P
authors.lastname: Vaňuga
authors.affiliation: 1st Department of Internal Medicine, Medical Faculty of PJ Šafárik University, University Hospital of L Pasteur, Košice, Slovakia.
authors.forename: I
authors.initials: I
authors.lastname: Lazurová
authors.affiliation: Department of Internal Medicine, 1st Private Hospital, Košice-Šaca, Slovakia.
authors.forename: S
authors.initials: S
authors.lastname: Tomková
authors.affiliation: 5th Department of Internal Medicine, Medical Faculty of Comenius University, University Hospital, Bratislava, Slovakia. Electronic address: payer@ru.unb.sk.
authors.forename: J
authors.initials: J
authors.lastname: Payer
mesh_terms: D000328:Adult; D017668:Age of Onset; D015415:Biomarkers / Q000032:analysis*; D015519:Bone Density / Q000187:drug effects*; D001846:Bone Development / Q000187:drug effects*; D016723:Bone Remodeling / Q000187:drug effects*; D002648:Child; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000009:adverse effects / Q000172:deficiency* / Q000494:pharmacology*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D010024:Osteoporosis / Q000188:drug therapy / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I
keywords: Bone mineral density; Bone turnover marker; Growth hormone; IGF-1; Trabecular bone score