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[Long-term effects of 7-year growth hormone substitution on bone metabolism, bone density, and bone quality in growth hormone-deficient adults].
Med Klin (Munich) 2004; 99(10):569-77MK

Abstract

BACKGROUND AND PURPOSE

Subnormal bone mineral density (BMD) and increased fracture risk are described in patients with growth hormone deficiency (GHD). Growth hormone (GH) has been reported to have beneficial effects on bone in GHD. The aim of this study was to investigate the long-term effects of GH replacement therapy on bone metabolism, BMD, and bone quality in patients with GHD.

PATIENTS AND METHODS

20 adult patients with GHD (eleven male, nine female, mean age 42.5 years) were included in the study and randomized to either GH or placebo in a dose of 0.25 U/kg body weight/week. After 6 months all patients received GH. After a 1-year double-blind, placebo-controlled study the patients were followed for another 72 months in an open study. The patients were compared to 20 age- und sex-matched healthy controls. Bone turnover was determined by ICTP (type I collagen carboxyterminal cross-linked telopeptide) as parameter of bone resorption and PICP (carboxyterminal propeptide of type I procollagen) as marker of bone formation. BMD was measured at the lumbar spine by dual-photon absorptiometry (DPA) and at the forearm by single-photon absorptiometry (SPA). Apparent phalangeal ultrasound transmission velocity (APU) was assessed as parameter of bone quality independent of BMD.

RESULTS

At the beginning of the study BMD at both measuring sites was lower in patients with GHD than in healthy controls. During the 1st year of GH replacement therapy BMD decreased, followed by a continuous increase in BMD (about 12%) up to 60 months which remained unchanged thereafter, building up a plateau. After 72 months no significant difference between the patients and the healthy controls could be detected. Concerning parameters of bone turnover, first ICTP as marker of bone resorption showed a significant increase, later on the marker of bone formation increased as well. APU decreased during the first 6 months of treatment, but had returned to its baseline value after 24 months and remained unchanged throughout the rest of the study.

CONCLUSION

BMD is subnormal in adults with GHD. GH replacement therapy stimulates bone turnover in patients with GHD and in the long term such stimulation results in an increased BMD. Thereby, GH shows a triphasic action on BMD: an initial decrease in BMD during the 1st year, followed by a continuous increase in BMD with buildup of a stable plateau after 60 months. The newly formed bone seems to have normal bone elasticity.

Authors+Show Affiliations

Fachbereich Endokrinologie/Diabetologie, Deutsche Klinik für Diagnostik, Aukammallee 33, 65191 Wiesbaden, Germany. wilhelm.end@dkd-wiesbaden.deNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
English Abstract
Journal Article
Randomized Controlled Trial

Language

ger

PubMed ID

15490072

Citation

Wilhelm, Birgit, and Peter Herbert Kann. "[Long-term Effects of 7-year Growth Hormone Substitution On Bone Metabolism, Bone Density, and Bone Quality in Growth Hormone-deficient Adults]." Medizinische Klinik (Munich, Germany : 1983), vol. 99, no. 10, 2004, pp. 569-77.
Wilhelm B, Kann PH. [Long-term effects of 7-year growth hormone substitution on bone metabolism, bone density, and bone quality in growth hormone-deficient adults]. Med Klin (Munich). 2004;99(10):569-77.
Wilhelm, B., & Kann, P. H. (2004). [Long-term effects of 7-year growth hormone substitution on bone metabolism, bone density, and bone quality in growth hormone-deficient adults]. Medizinische Klinik (Munich, Germany : 1983), 99(10), pp. 569-77.
Wilhelm B, Kann PH. [Long-term Effects of 7-year Growth Hormone Substitution On Bone Metabolism, Bone Density, and Bone Quality in Growth Hormone-deficient Adults]. Med Klin (Munich). 2004 Oct 15;99(10):569-77. PubMed PMID: 15490072.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Long-term effects of 7-year growth hormone substitution on bone metabolism, bone density, and bone quality in growth hormone-deficient adults]. AU - Wilhelm,Birgit, AU - Kann,Peter Herbert, PY - 2004/04/21/received PY - 2004/07/06/revised PY - 2004/10/19/pubmed PY - 2004/12/21/medline PY - 2004/10/19/entrez SP - 569 EP - 77 JF - Medizinische Klinik (Munich, Germany : 1983) JO - Med. Klin. (Munich) VL - 99 IS - 10 N2 - BACKGROUND AND PURPOSE: Subnormal bone mineral density (BMD) and increased fracture risk are described in patients with growth hormone deficiency (GHD). Growth hormone (GH) has been reported to have beneficial effects on bone in GHD. The aim of this study was to investigate the long-term effects of GH replacement therapy on bone metabolism, BMD, and bone quality in patients with GHD. PATIENTS AND METHODS: 20 adult patients with GHD (eleven male, nine female, mean age 42.5 years) were included in the study and randomized to either GH or placebo in a dose of 0.25 U/kg body weight/week. After 6 months all patients received GH. After a 1-year double-blind, placebo-controlled study the patients were followed for another 72 months in an open study. The patients were compared to 20 age- und sex-matched healthy controls. Bone turnover was determined by ICTP (type I collagen carboxyterminal cross-linked telopeptide) as parameter of bone resorption and PICP (carboxyterminal propeptide of type I procollagen) as marker of bone formation. BMD was measured at the lumbar spine by dual-photon absorptiometry (DPA) and at the forearm by single-photon absorptiometry (SPA). Apparent phalangeal ultrasound transmission velocity (APU) was assessed as parameter of bone quality independent of BMD. RESULTS: At the beginning of the study BMD at both measuring sites was lower in patients with GHD than in healthy controls. During the 1st year of GH replacement therapy BMD decreased, followed by a continuous increase in BMD (about 12%) up to 60 months which remained unchanged thereafter, building up a plateau. After 72 months no significant difference between the patients and the healthy controls could be detected. Concerning parameters of bone turnover, first ICTP as marker of bone resorption showed a significant increase, later on the marker of bone formation increased as well. APU decreased during the first 6 months of treatment, but had returned to its baseline value after 24 months and remained unchanged throughout the rest of the study. CONCLUSION: BMD is subnormal in adults with GHD. GH replacement therapy stimulates bone turnover in patients with GHD and in the long term such stimulation results in an increased BMD. Thereby, GH shows a triphasic action on BMD: an initial decrease in BMD during the 1st year, followed by a continuous increase in BMD with buildup of a stable plateau after 60 months. The newly formed bone seems to have normal bone elasticity. SN - 0723-5003 UR - https://www.unboundmedicine.com/medline/citation/15490072/[Long_term_effects_of_7_year_growth_hormone_substitution_on_bone_metabolism_bone_density_and_bone_quality_in_growth_hormone_deficient_adults]_ L2 - https://dx.doi.org/10.1007/s00063-004-1088-4 DB - PRIME DP - Unbound Medicine ER -