Changes in Bone Mineral Density, Body Composition, and Lipid Metabolism during Growth Hormone (GH) Treatment in Children with GH Deficiency¹

Abstract

Adults with childhood onset GH deficiency (GHD) have reduced bone mass, increased fat mass, and disorders of lipid metabolism. The aim of the present study was to evaluate bone mineral density (BMD), bone metabolism, body composition, and lipid metabolism in GHD children before and during 2-3 yr of GH treatment (GHRx). Forty children with GHD, mean age 7.9 yr, participated in the study of bone metabolism and body composition; and an additional group of 17 GHD children, in the study of lipid metabolism. Lumbar spine BMD, total body BMD, and body composition were measured with dual-energy x-ray absorptiometry. Volumetric BMD (bone mineral apparent density, BMAD) was calculated to correct for bone size. BMD, BMAD, lean tissue mass, bone mineral content, fat mass, and percentage body fat were expressed as SD scores (SDS), in comparison with normative data of the same population. Lumbar spine BMD and BMAD and total body BMD were all decreased at baseline. All BMD variables increased significantly during GHRx, lumbar spine BMD SDS, already after 6 months of treatment. Lean tissue mass SDS increased continuously. Bone mineral content SDS started to increase after 6 months GHRx. Fat mass SDS decreased during the first 6 months of GHRx and remained stable thereafter. Biochemical parameters of bone formation and bone resorption did not differ from normal at baseline and increased during the first 6 months of GHRx. Serum 1,25 dihydroxyvitamin D increased continuously during GHRx, whereas PTH and serum calcium remained stable. Lipid profile was normal at baseline: Atherogenic index had decreased and apolipoprotein A1(Apo-A1) had increased after 3 yr of treatment. In conclusion, children with GHD have decreased bone mass. BMD, together with height and lean tissue mass, increased during GHRx. GHRx had a beneficial effect on lipid metabolism.

Vitamin D and growth hormone in children: a review of the current scientific knowledge

“…Also in 1997, Boot and colleagues in their prospective study analyzed 40 children with GHD and found an increase of the 1,25(OH) 2 D levels during the substitution treatment with rGH, without variations in PTH and the calcium levels. At baseline, the values of 1,25(OH) 2 D were in the normal range, which excluded the presence of a basal hypovitaminosis D. The 25(OH)D values are not known because they were not considered in this study [80].…”

Evaluation of the Osteogenic Potential of Stem Cells in the Presence of Growth Hormone under Magnetic Field Stimulation

“…The bone growth and development are profoundly affected by the growth hormone (GH) and other factors such as insulin-like growth factor (IGF). It has been shown that hyposecretion of GHs causes a decrease in bone mineral density (BMD), while GH facilitates bone growth and strength . IGF is essential for bone growth and maturation .…”

Growth Hormone Deficiency: Is It Just a Problem of Growth Impairment? Part II

“…GH treatment increases plasma phosphate concentrations in GHD children [73,74] and adults [52,53,75]. In contrast to plasma calcium concentrations, this increase in plasma phosphate persisted during 12-24 months of GH therapy [53,[73][74][75], while urinary phosphate excretion was decreased. .…”

“…It is well known that adult GHD patients present osteoporosis with a high risk of vertebral and femoral fractures. Low bone mass can be partially improved by GH replacement [70][71][72][73] because GH therapy in GHD adults causes a transient increase in plasma calcium concentrations and urinary calcium excretion, which usually lasts between 3 and 6 months.…”