Growth hormone treatment and the risk of adolescent scoliosis: A large matched cohort study

Abstract

Aim:We aimed to evaluate the risk of developing adolescent scoliosis among recipients of recombinant human growth hormone (rhGH).Methods: This registry-based cohort study included 1314 individuals who initiated rhGH treatment since 2013, treated during 10-18 years of age for at least 6 months. This group was matched to a comparison group of 6570 individuals not treated with rhGH. Demographic and clinical information was extracted from the electronic database. The results are presented using hazard ratios (HR) and 95% confidence intervals (CI).Results: During a median follow-up of 4.2 years, 59 (4.5%) rhGH recipients and 141 individuals (2.1%) from the comparison group were diagnosed with adolescent scoliosis. The age at diagnosis did not differ between the groups (14.7 versus 14.3 years, p = 0.095). Patients treated with rhGH were more likely diagnosed with scoliosis (HR 2.12, 95% CI 1.55-2.88, p < 0.001). Among males, the risk was about three times greater in the treated versus the comparison group (HR 3.15, 95% CI 2.12-4.68, p < 0.001), while in females the risk was not increased (HR 1.12, 95% CI 0.72-2.04, p = 0.469). Conclusions:Recombinant human growth hormone treatment was associated with an increased risk to be diagnosed with adolescent scoliosis in males. Scoliosis development should be monitored appropriately in rhGH recipients. K E Y W O R D S adolescents, recombinant human growth hormone, scoliosis, side effects 1 | INTRODUC TI ON Scoliosis, a three-dimensional spinal deformity, is the most common spinal disorder in children and adolescents. It is defined as a lateral curvature of the spine that is 10° or greater, according to measurement by the Cobb angle. In paediatric patients, scoliosis can be classified by aetiology into congenital, neuromuscular, syndrome-related and idiopathic. Idiopathic

Orthopedic manifestations in children with Prader-Willi syndrome

“…One study showed that rhGH increases the risk of scoliosis in adolescents. 11 A larger sample of data may be needed for support. Current research has shown that the long-term use of rhGH can improve the body composition of 14 Scoliosis should not be considered a reason for refusing rhGH treatment.…”

“…rhGH therapy has been considered a possible risk factor for the onset of scoliosis in some studies. 11 However, others have demonstrated that rhGH therapy is not related to the occurrence and development of scoliosis. 7,12,13 This may be related to the population, dose, and age of the patient; however, largesample studies in patients with scoliosis treated with rhGH are still lacking.…”

Complex Interplay of Psychiatry Disorders, Fractures, and Osteoporosis: A Mendelian Randomization Study

“…Research highlights the statistical signi cance (P < 0.001) of this heightened fracture risk, encompassing regions such as the skull, neck, and trunk (HR = 1.53), upper limbs (HR = 1.28), and lower extremities (HR = 1.84) [5]. Moreover, studies indicate a correlation between ADHD symptoms and limb fractures in adults [8], with a notable reduction in fracture risk for individuals receiving pharmacological interventions [9,10].…”

“…Some of these occurrences can be attributed to the unique characteristics of ADHD [78]. Impulsivity, which is a characteristic symptom of ADHD, results in impulsive actions, poor judgment, and a preference for immediate grati cation [10,78]. Research indicates that children with ADHD, despite being capable of recognizing dangers, tend to underestimate the severity of consequences arising from their behaviors [79].…”

“…Notably, ADHD is associated with an increased risk of fractures, highlighting the importance of recognizing the elevated risk in individuals with ADHD [3][4][5][6].The core features of ADHD involve attention de cits, heightened hyperactivity, and impulsive behaviors.Notably, children with ADHD face an elevated risk of fractures, particularly affecting the skull, neck, trunk, and intracranial structures, with a Hazard Ratio (HR) 3.07 times higher than neurotypical peers [7].Research highlights the statistical signi cance (P < 0.001) of this heightened fracture risk, encompassing regions such as the skull, neck, and trunk (HR = 1.53), upper limbs (HR = 1.28), and lower extremities (HR = 1.84) [5]. Moreover, studies indicate a correlation between ADHD symptoms and limb fractures in adults [8], with a notable reduction in fracture risk for individuals receiving pharmacological interventions [9,10].ASD comprises a spectrum of developmental, psychological, and neurological conditions emerging in early childhood [11]. Notably, individuals within the ASD spectrum exhibit an increased susceptibility to injuries involving the head, face, and neck [12], as well as a heightened risk of fractures affecting the hip, forearm, and spine [13].…”