Changes in bone mineral density after discontinuation and early reinstitution of growth hormone (GH) in patients with childhood-onset GH deficiency

Benbassat, Carlos; Wasserman, M; Laron, Zvi

doi:10.1054/ghir.1999.0118

Cited by 14 publications

(9 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Changes in BMC or bone structure can only be detected after longer-term GH therapy, and GH-induced improve-ments have been reported to develop several months after interruption of GH therapy (41). It is therefore not surprising that no changes in BMC were observed after 6 months with a different GH treatment regimen.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Effects of Continuous Subcutaneous InfusionVersusDaily Subcutaneous Injections of Growth Hormone (GH) on the Insulin-Like Growth Factor System, Insulin Sensitivity, Body Composition, and Bone and Lipoprotein Metabolism in GH-Deficient Adults¹

Laursen

Gravholt

Heickendorff

et al. 2001

The Journal of Clinical Endocrinology & Metabolism

View full text Add to dashboard Cite

It remains uncertain whether close imitation of the physiological pulsatile GH pattern determines the effects of GH treatment in humans. However, human studies have reported comparable metabolic responses to short-term constant and intermittent GH exposure. The aim of the study was to compare the metabolic effects of GH after continuous and intermittent sc delivery. In a parallel design, 14 GH-treated GH-deficient patients (mean age, 37 yr; mean body mass index, 27.4 kg/m(2)) were studied during steady state at the start of the study and after 6 months. Seven patients received daily injections (inj) in the evening as usual, and 7 received a continuous infusion (inf) of GH by means of a portable pump. The GH dose was kept unchanged before and during the study. Serum levels of insulin-like growth factor I (IGF-I) tended to increase in the patients switched to constant infusion (from 175 +/- 36 to 209 +/- 50 microg/L), but the differences obtained during the two regimens [+34.3 (inf) vs. -11.9 (inj)] were not significant (P = 0.34). Serum levels of IGF-II (P = 0.71) and IGF-binding protein (IGFBP)-3 (P = 0.75) were identical during the two modes of treatment. Serum levels of IGFBP-1 (P = 0.72), IGFBP-2 (P = 0.34), and GH-binding protein (P = 0.75) were unaffected by treatment regimen. Serum levels of free fatty acids, reflecting lipolysis, decreased significantly (16%) in the group switched to GH infusion (difference, -99.8 vs. +5 micromol/L; P< 0.03). The GH pattern did not influence insulin sensitivity (P = 0.71) or glucose effectiveness (P = 0.15) derived from Bergman's minimal model. Similarly, the two treatment regimens had no differential impact on lipoprotein levels, bone metabolism, or body composition. In conclusion, continuous and intermittent administrations of GH for 6 months are comparable with respect to the IGF-IGFBP axis, whereas intermittent exposure may be of importance for the lipolytic effect of GH. The data on insulin sensitivity and lipoproteins suggest that constant GH exposure is as safe as intermittent GH administration.

show abstract

Section: Discussionmentioning

confidence: 99%

Long-Term Effects of Continuous Subcutaneous InfusionVersusDaily Subcutaneous Injections of Growth Hormone (GH) on the Insulin-Like Growth Factor System, Insulin Sensitivity, Body Composition, and Bone and Lipoprotein Metabolism in GH-Deficient Adults¹

Laursen

Gravholt

Heickendorff

et al. 2001

The Journal of Clinical Endocrinology & Metabolism

View full text Add to dashboard Cite

show abstract

“…Neither bone mineral content (BMC), nor bone markers of formation or resorption in serum or urine, however, responded differently to the mode of GH delivery [139]. While many biochemical markers change within days or weeks in response to GH therapy [183,309], detection of changes in BMC or BMD would have required more than a six months treatment period, as they may occur several months after discontinuation of GH therapy [310].…”

Section: Lipoprotein Metabolismmentioning

confidence: 99%

Clinical pharmacological aspects of growth hormone administration

Laursen

2004

Growth Hormone & IGF Research

View full text Add to dashboard Cite

“…At final height, normal (60,61) or reduced (62) mean values of lumbar BMD were found in GH-treated GHD patients. Approximately 20% of GHD children treated with GH had a value of lumbar BMD between 2 1 and 2 2 S.D.…”

Section: Gh Treatmentmentioning

confidence: 91%

“…of the normal mean at final height, with increased susceptibility to fractures during GH treatment (61). Reduced lumbar BMD was found expecially in patients with GHD who had received interrupted and low-dose GH treatment during the period of pituitary-derived GH during childhood (44,59), but it has been shown that there was no difference in lumbar BMD at final height between patients with GHD who had received standard (0.3 mg/kg per week) or high GH dosage (0.7 mg/kg per week) (62).…”

Section: Gh Treatmentmentioning

confidence: 99%

Bone development during GH and GnRH analog treatment

Antoniazzi

Zamboni

Bertoldo

et al. 2004

European Journal of Endocrinology

View full text Add to dashboard Cite

Estrogens, GH and IGFs are essential in the development and growth of the skeleton and for the maintenance of bone mass and density. Treatment of precocious puberty with GnRH analogs (GnRHa), by reducing sex steroid levels, leads to a situation of hypoestrogenism that may theoretically have a detrimental effect on bone mass during pubertal development. A reduction in bone mineral density (BMD) during GnRHa treatment has been demonstrated, but GnRHa treatment in patients with central precocious puberty (CPP) does not seem to impair the achievement of normal peak bone mass (PBM) at final height. However, calcium supplementation is effective in improving bone densitometric levels and may promote better PBM achievement. In children and adolescents with GH deficiency (GHD), BMD assessed by dual-energy X-ray absorptiometry (DEXA) and bone turnover are significantly reduced, but they are stimulated by GH treatment. GH treatment leads to improved bone density, function of the dose and duration of treatment, and patients may require prolonged GH treatment beyond the time of growth to improve PBM. After the discontinuation of GH therapy, the more active population had higher bone mineral content (BMC) levels than patients with low physical activity. In our experience, the therapeutic association of GH and calcium also represents a valuable tool in pursuing a proper BMC in GHD patients. We concluded that nonhormonal factors, such as physical activity and nutritional factors, are important in determining bone metabolism and bone mass. European Journal of Endocrinology 151 S47-S54

show abstract

Changes in bone mineral density after discontinuation and early reinstitution of growth hormone (GH) in patients with childhood-onset GH deficiency

Cited by 14 publications

References 21 publications

Long-Term Effects of Continuous Subcutaneous InfusionVersusDaily Subcutaneous Injections of Growth Hormone (GH) on the Insulin-Like Growth Factor System, Insulin Sensitivity, Body Composition, and Bone and Lipoprotein Metabolism in GH-Deficient Adults¹

Long-Term Effects of Continuous Subcutaneous InfusionVersusDaily Subcutaneous Injections of Growth Hormone (GH) on the Insulin-Like Growth Factor System, Insulin Sensitivity, Body Composition, and Bone and Lipoprotein Metabolism in GH-Deficient Adults¹

Clinical pharmacological aspects of growth hormone administration

Bone development during GH and GnRH analog treatment

Contact Info

Product

Resources

About

Changes in bone mineral density after discontinuation and early reinstitution of growth hormone (GH) in patients with childhood-onset GH deficiency

Cited by 14 publications

References 21 publications

Long-Term Effects of Continuous Subcutaneous InfusionVersusDaily Subcutaneous Injections of Growth Hormone (GH) on the Insulin-Like Growth Factor System, Insulin Sensitivity, Body Composition, and Bone and Lipoprotein Metabolism in GH-Deficient Adults1

Long-Term Effects of Continuous Subcutaneous InfusionVersusDaily Subcutaneous Injections of Growth Hormone (GH) on the Insulin-Like Growth Factor System, Insulin Sensitivity, Body Composition, and Bone and Lipoprotein Metabolism in GH-Deficient Adults1

Clinical pharmacological aspects of growth hormone administration

Bone development during GH and GnRH analog treatment

Contact Info

Product

Resources

About

Long-Term Effects of Continuous Subcutaneous InfusionVersusDaily Subcutaneous Injections of Growth Hormone (GH) on the Insulin-Like Growth Factor System, Insulin Sensitivity, Body Composition, and Bone and Lipoprotein Metabolism in GH-Deficient Adults¹

Long-Term Effects of Continuous Subcutaneous InfusionVersusDaily Subcutaneous Injections of Growth Hormone (GH) on the Insulin-Like Growth Factor System, Insulin Sensitivity, Body Composition, and Bone and Lipoprotein Metabolism in GH-Deficient Adults¹