Growth hormone deficiency during puberty reduces adult bone mineral density.

Hyer, SL; Rodin, DA; Tobias, J.H.; Leiper, AD; Nussey, S. S.

doi:10.1136/adc.67.12.1472

Cited by 120 publications

(44 citation statements)

References 17 publications

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“…Leukemic invasion of bone is not uncommon in ALL . Other risk factors for osteoporosis include corticosteroid [54] and methotrexate therapy [55][56][57][58][59][60][61]; local and cranial radiation [62,63]; and deficiency of various hormones [64]. Decreased activity [25] because of limited exercise capacity and physical inactivity, as well as nutritional deficiency [28] resulting in altered calcium, vitamin D, and magnesium metabolism, must be given consideration.…”

Section: Risk Factors For Osteoporosismentioning

confidence: 99%

Osteoporosis in Survivors of Acute Lymphoblastic Leukemia

2001

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Osteoporosis is currently receiving increasing attention as an important late effect in survivors of childhood cancer and its treatment because of their quality of life and its negative effect on the survivors' ability to perform developmentally appropriate activities. Survivors of childhood cancer are especially vulnerable because they are affected during childhood and adolescence, a time when peak bone mass should be achieved. This paper reviews decreased bone density in acute lymphoblastic leukemia (ALL), which is the most common childhood cancer and has a cure rate approaching 80%. Osteopenia/osteoporosis has been observed in all phases of the disease: at diagnosis, during treatment, and throughout the post-treatment period for as long as 20 years. Among the findings that have been described are musculoskeletal pain, disturbed gait, fractures, kyphosis, lordosis, and growth failure. Risk factors not specifically related to ALL include smoking, ingestion of carbonated beverages, and family history of "brittle bone" or fractures. Patients should be counseled in regard to diet, exercise, smoking cessation, and avoidance of carbonated beverages. There are a number of options for specific drug therapy; however, the administration of bisphosponates to children and adolescents must be approached with caution. Research is needed to determine how extensive the problem is and how to best prevent and treat the osteopenia/osteoporosis associated with ALL.

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Section: Risk Factors For Osteoporosismentioning

confidence: 99%

Osteoporosis in Survivors of Acute Lymphoblastic Leukemia

2001

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“…In GHD children, there is an increased risk of fractures (1), and reduced bone mineral density (BMD) has been reported (2). Furthermore, the treatment (e.g., irradiation) of children with pituitary disease eventually aggravates these disturbances, and may to some extent eclipse the relative impact of GHD (3).…”

Section: Introductionmentioning

confidence: 99%

Morbidity and GH deficiency: a nationwide study.

Stochholm

Laursen

Green

et al. 2008

European Journal of Endocrinology

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Objective: To estimate morbidity in Denmark in all patients with GH deficiency (GHD). Design: Morbidity was analyzed in 1794 GHD patients and 8014 controls matched on age and gender. All records in the GHD patients were studied and additional morbidity noted. Diagnoses and dates of admissions were identified in the National Patient Registry. Lag time until first admission was used as a measure of morbidity. Patients were divided into childhood onset (CO) and adult onset (AO), discriminated by an age cut-off of 18 years at onset of GHD. Method: Sex-and cause-specific hazard ratios (HRs) in CO and AO GHD compared with controls. Results: Total morbidity was significantly increased in the GHD patients. HR for CO males: 3.1 (95% confidence interval (CI): 2.7-3.7), CO females: 3.2 (95% CI: 2.6-3.9), AO males: 2.9 (95% CI: 2.6-3.2), and AO females: 3.2 (95% CI: 2.8-3.6). In 18 out of 20 chapters from the International Classification of Diseases-10, a significantly increased morbidity was identified for at least one of the four subgroups of patients. Morbidity was significantly increased in all the four subgroups due to infectious, endocrine, pulmonary, urogenital, and neurological diseases; cancer; diseases of the eye, ear, and circulatory diseases; and traumas. Fractures were significantly increased in AO females, not in males.

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“…Early changes in bone density measurements may reflect changes in bone size, but prolonged treatment results in improvement in net bone formation (42). Longitudinal data in GHD children treated for an average of 4 years demonstrated a significant improvement in radial and lumbar bone density.…”

Section: Gh Treatmentmentioning

confidence: 98%

“…In children and adolescents with GHD, BMD assessed by DEXA and bone turnover are significantly reduced (40), reflecting decreased bone modeling and remodeling (41), because of delayed bone maturation or absence of GH anabolic activity (42).…”

Section: Gh Deficiency (Ghd)mentioning

confidence: 99%

Bone development during GH and GnRH analog treatment

Antoniazzi

Zamboni

Bertoldo

et al. 2004

European Journal of Endocrinology

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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

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Growth hormone deficiency during puberty reduces adult bone mineral density.

Cited by 120 publications

References 17 publications

Osteoporosis in Survivors of Acute Lymphoblastic Leukemia

Osteoporosis in Survivors of Acute Lymphoblastic Leukemia

Morbidity and GH deficiency: a nationwide study.

Bone development during GH and GnRH analog treatment

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