Positive effects of short-term growth hormone treatment on lean body mass and BMC after a hip fractureA double-blind placebo-controlled pilot study in 20 patients

Abstract

Background A catabolic state develops after a hip fracture, with loss of muscle and bone tissue. Growth hormone (GH) treatment has been shown to exert anabolic effects during other catabolic states. We investigated whether GH given postoperatively to elderly hip fracture patients could increase serum insulin-like growth factor-I (IGF-I) and reduce the loss of lean body mass and bone mineral content (BMC) without considerable side effects.Patients and methods We randomized 20 patients operated on for a hip fracture to a double-blind placebocontrolled 4-week study with daily subcutaneous injections of GH or placebo. The patients were followed for another 2 months after termination of GH treatment.Results Serum IGF-I and the IGF-I binding protein 1 (IGFBP-1) were measured by specifi c radioimmunoassay (RIA) technique. BMC and lean body mass were assessed by dual-energy X-ray absorptiometry and quantitative computed tomography. Serum IGF-I increased signifi cantly during GH treatment, which also preserved lean body mass and BMC without serious adverse events.

Systemic response of the GH/IGF-I axis in timely versus delayed fracture healing

“…Various authors documented the therapeutic use of GH and IGFs on acceleration of fracture healing mostly in animal models with partly conflicting and controversial results [22][23][24][25][26]. In the few clinical trials heading systemic administration of GH in patients, the hormone failed to improve rate and quality of fracture healing [31] while it increased bone mineral content [27] and rate of return to the pre-fracture living situation in the elderly with hip fractures [28]. Even less information is available on therapeutic use of GH/ IGF system in failed fracture healing.…”

Metabolism and catabolism in hip fracture patients: Nutritional and anabolic intervention—a review

“…A small double-blind study reported a lean body-preserving effect of short-term GH treatment (Hedström et al 2004) (Table) and another double-blind short-term GH therapy study showed a faster return to prefracture living (van der Lely et al 2000) (Table). This was in contrast to a recent 6 month-study with oral GH secretagogue given to hip fracture patients who reported no functional improvement from this treatment (Bach et al 2004) (Table).…”

“…This was in contrast to a recent 6 month-study with oral GH secretagogue given to hip fracture patients who reported no functional improvement from this treatment (Bach et al 2004) (Table). Moreover, there have been reports of serious side effects of GH treatment in acute critically ill patients (Takala et al 1999), but not in hip fracture patients when therapy was started 3-4 days postoperatively (Yeo et al 2003, Hedström et al 2004. Daily infusions of recombinant IGF-I/ IGFBP-3 complex for 2 months in hip fracture Table).…”

Growth hormone: does it have a therapeutic role in fracture healing?

“…Recent human studies on the effects of GH on patients sustaining fractures place emphasis on the functional recovery of patients; therefore, most of the published data include indirect evidence of fracture healing. The intended benefit of GH administration in human fracture patients in most of the available studies has been to determine the systemic effect against the catabolic state that these patients enter after their injury/operation [133,[136][137][138][139][140].…”