Growth hormone replacement in adults and bone mineral density: a systematic review and meta‐analysis

Davidson, Peter; Milne, Ruairidh; Chase, Deborah; Cooper, Cyrus

doi:10.1111/j.1365-2265.2004.01935.x

Cited by 53 publications

(35 citation statements)

References 31 publications

(30 reference statements)

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“…Low bone mass has been shown to be less frequent with increasing age in patients with GHD (34). Furthermore, in a meta-analysis, treatment with GH has not been shown to improve BMD in this patient group (35). In our study we found no correlation between BMD or markers of bone turnover and spontaneous growth hormone secretion.…”

Section: Discussioncontrasting

confidence: 52%

Bone mineral density and bone turnover in young adult survivors of childhood acute lymphoblastic leukaemia

Jarfelt¹,

Fors²,

Lannering³

et al. 2006

eur j endocrinol

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Objective: Treatment for childhood leukaemia induces many risk factors for development of decreased bone mineral density (BMD). Physical activity is also known to affect BMD. The aim was to study BMD and markers of bone turnover in a well-defined group of survivors of acute lymphoblastic leukaemia (ALL) who had all reached final height as well as peak bone mass, taking both previous treatment and physical activity into consideration. Design: All patients treated for ALL before the onset of puberty in the region of western Sweden, between 1973 and 1985, in first remission were included. Thirty-five out of forty-seven patients aged 20 -32 years participated. Nineteen patients had received cranial radiotherapy, and the median follow-up time was 20 years. Methods: BMD was assessed using dual-energy X-ray absorbtiometry (DEXA). Serum concentrations of markers of bone turnover were analysed. Physical performance was measured using a performance exercise capacity stress test. Results: BMD was slightly reduced in lumbar spine (2 0.4 SD), but not in femoral neck or total body. BMD in femoral neck was correlated to physical performance and dose of corticosteroid, but no correlation was found with spontaneous growth hormone (GH) secretion. Markers of bone turnover were also correlated to physical performance, but not to GH secretion. Conclusions: Physical fitness seems to be the most important factor in developing and preserving normal bone mineral density in ALL patients. We propose that lifestyle education promoting physical activity is encouraged from an early point in time for these patients.

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Section: Discussioncontrasting

confidence: 52%

Bone mineral density and bone turnover in young adult survivors of childhood acute lymphoblastic leukaemia

Jarfelt¹,

Fors²,

Lannering³

et al. 2006

eur j endocrinol

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“…Second, increases in markers of bone remodeling occur during GH replacement therapy in adults with GHD (3,4,8,15). Finally, accumulated evidence supports the finding that GH replacement in children (3,16) and adults with GHD (8,17,18) improves BMD.…”

Section: Introductionsupporting

confidence: 50%

Treatment for 24 months with recombinant human GH has a beneficial effect on bone mineral density in young adults with childhood-onset GH deficiency

Conway

Szarras‐Czapnik

Rácz

et al. 2009

European Journal of Endocrinology

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Objective: Discontinuation of growth hormone (GH) therapy on completion of linear growth may adversely affect bone mineral density (BMD) in young adults with childhood-onset GH-deficiency (GHD). In the present study, we analyzed the impact of GH treatment on bone in young adults with GHD. Methods: BMD at the lumbar spine (L2-L4), total hip, and total body was measured at baseline and after 24 months in a cohort of young adults (18-25 years; nZ160) with severe GHD treated with GH during childhood who were randomized to GH (nZ109) or no treatment (nZ51) in a multicenter, multinational, open-label study. GH starting doses (0.2 mg/day (males), 0.4 mg/day (females)) were increased after 1 month to 0.6 mg/day (males) and 0.9 mg/day (females) and then to 1.0 mg/day (males) and 1.4 mg/day (females) at 3 months for the remainder of the study. Results: After 24 months, lumbar spine BMD had increased significantly more in GH-treated patients than in controls (6 vs 2%; estimated treatment difference; 3.5% (95% confidence interval, 1.52-5.51) P!0.001). GH also had a significant positive effect on total hip BMD (PZ0.015). Total body BMD was unchanged from baseline (PZ0.315). Conclusions: In young adults treated for childhood-onset GHD, there is a beneficial effect of continued GH treatment on BMD in adult life. Twenty-four months of GH treatment in these young adults was associated with an estimated 3.5% greater increase in BMD of the lumbar spine compared with controls.

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“…Em DGHA, os marcadores bioquímicos de remodelação óssea estão normais ou diminuídos e há diminuição do turnover ósseo (26). A redução de densidade mineral óssea em DGHA é provavelmente resultado de diminuição de formação óssea.…”

Section: Densidade Mineral óSseaunclassified

“…A redução de densidade mineral óssea em DGHA é provavelmente resultado de diminuição de formação óssea. Esta redução é referida em pacientes com DGHA-II e DGH-IA, seja com DGHA isolada ou com deficiência hipofisária múltipla (26).…”

Section: Densidade Mineral óSseaunclassified

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Deficiência de GH na vida adulta: como diagnosticar e quando tratar?

Jallad

Bronstein

2008

Arq Bras Endocrinol Metab

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A deficiência de hormônio do crescimento (dgH) na vida adulta (dgHA) é entidade clínica bem estabelecida, com características heterogêneas e na qual as principais etiologias são as neoplasias da região hipotálamo-hipofisária e/ou seus tratamentos. o seu diagnóstico deve ser considerado em indivíduos com evidência de comprometimento na região hipotálamo-hipofisária, e naqueles com dgHA de início na infância. nos indivíduos que preencham estes critérios, o diagnóstico bioquímico é realizado por meio de testes dinâmicos de estímulo da secreção de gH, uma vez que seus marcadores de ação: igF-1 e igFBP-3 podem não distinguir indivíduos normais e pacientes com dgH. comparado à reposição de gH realizada com dose calculada, segundo o peso ou a superfície corpórea, o tratamento atual, usando dose inicial baixa seguida pelo ajuste individualizado da dose de acordo com os níveis séricos de igF-1, determina efeito benéfico similar com incidência menor de efeitos colaterais, melhor tolerância ao tratamento e menor dose de manutenção. os potenciais benefícios da reposição devem ser analisados de maneira crítica e individualizada, pois nem todo o paciente apresentará benefício suficiente para justificar o tratamento. A disponibilidade de alternativas terapêuticas igualmente eficazes deve ser levada em consideração. A atividade física programada pode ocasionar melhora na composição corpórea, na capacidade cardiovascular e no bem-estar psicológico de indivíduos com dgHA sem reposição. o impacto do tratamento com hrgH sobre a qualidade de vida do paciente é importante por tornar o indivíduo mais apto social e economicamente. os dados epidemiológicos indicam redução na expectativa de vida em pacientes com dgHA, mas a sua normalização com hrgH permanece questionável. (Arq Bras Endocrinol Metab 2008; 52/5:861-871) Descritores: gH; deficiência de gH; deficiência de gH no adulto; hipopituitarismo; tratamento com hrgH ABSTRAcT Growth Hormone Deficiency in Adulthood: how to diagnose and when to treat? Adult growth hormone deficiency (AgHd) is a well-established clinical entity with heterogeneous characteristics, in which the main causes are hypothalamus-pituitary tumors and/or their treatment. the diagnosis of AdgH should be considered in patients with a prior history of childhood-onset gH deficiency or a history of organic hypothalamus-pituitary disease. in these patients diagnosis is performed biochemically by provocative tests of gH secretion, once the measurement of the biological markers for gH action:igFl and igFBP-3 levels, can be in the normal range in an important percentage of AgHd patients. the current treatment using an initial low dose of hrgH followed by individualised dose titration adjusted according to serum igF-1 levels, leads to similar beneficial effects with less incidence of side effects,

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Growth hormone replacement in adults and bone mineral density: a systematic review and meta‐analysis

Abstract: There is evidence of a small effect of GH replacement on bone mineral density in adults with GH deficiency. The clinical importance of this is uncertain.

Cited by 53 publications

References 31 publications

Bone mineral density and bone turnover in young adult survivors of childhood acute lymphoblastic leukaemia

Bone mineral density and bone turnover in young adult survivors of childhood acute lymphoblastic leukaemia

Treatment for 24 months with recombinant human GH has a beneficial effect on bone mineral density in young adults with childhood-onset GH deficiency

Deficiência de GH na vida adulta: como diagnosticar e quando tratar?

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