Background: Only few previous studies have assessed the effects of long-term growth hormone (GE-I) replacement therapy on bone mineral density (BMD) in adult patients with GH deficiency. The aim of this study was to investigate the effects of long-term GH therapy on bone metabolism and BMD. Material and methods: At the start of the study, 20 adults with GH deficiency were randomized to receive either GH, 0.25 lii x kg per week, or placebo. After 6 months, patients in the placebo group were switched to GE-I therapy, and they received GH for a further 18 months. Of the 20 patients, 14 were male and 6 female with GH deficiency of adult-onset. The mean age of the patients at the start of the study was 40.3±10.9 years and the duration of GH deficiency was 10.6 6.4 years. Patients deficient in pituitary hormones other than GE-I had been receiving stable replacement doses of appropriate hormones for at least 6 months before the start of the study. Rates of bone metabolism were assessed by measuring calcium, phosphate, alkaline phosphatase, calciuria, phosphaturia and osteocalcin. BMD was measured by dual Xray absorptiometry. Body composition was calculated from measurements of bioelectrical impedance. Results: Before GH treatment, BMD in the femoral neck was lower in patients than in controls. The rate of bone resorption markers increased significantly after 6 months and remained stable during the whole treatment period. BMD significantly increased in L2-L4 after 12 months of treatment with an increase of Z-score. The total BMD increase was 4.5±6.5%. BMD in the femoral neck increased after 12 months with an increase of Z-score after 18 months. The total increase was 10.4±18%. The total BMD increase was not different among patients with or without basal osteopenia.In both groups BMD in L2 -L4 and in the femoral neck remained stable after 12 months without GH treatment. Sex, age, BMI and the time in which GH deficiency started, before or after the end of the peak of BMD, did not correlate with BMD. The BMD values and their response to GH treatment did not correlate with other associated deficiencies, and we did not find differences among BMD increase and GH dose, levels of insulin-growth factor-I, insulin growth factor binding protein-3, and parameters of body composition. Conclusions: The result5 of the study support previous ones that BMD is subnormal in adults with GH deficiency; that GH replacement therapy stimulates bone turnover with initial biochemical changes; and that in the long term, this stimulation results in a significant augmentation in BMD that continues to increase after 2 years and remains stable after 12 months of GH withdrawal.

Durante o climatério, período em que as gônadas femininas cessam sua função, a deficiência de estrógenos, especialmente do estradiol, provoca alterações importantes na cavidade bucal, interferindo em mecanismos inflamatórios, secreção salivar, metabolismo do colágeno, entre outros. Por meio de uma revisão de literatura, esse estudo teve como objetivo, ver a influência das alterações hormonais advindas do período de climatério nos tecidos bucais, proporcionando ao cirurgião dentista informações em relação às consequências e cuidados relacionados a esta fase da vida da mulher. Nesse período, as mulheres tornam-se mais suscetíveis a alterações tais como: osteopenia e osteoporose dos maxilares, hipossalivação, doenças periodontais, entre outros. O tratamento preventivo por meio de remoção de placa, adequação do meio bucal e orientação antes e durante o climatério são os melhores meios de minimizar os problemas bucais advindos dessa fase da vida da mulher.