The effect of cessation of human growth hormone HGH therapy on bone mineral accretion in HGH deficient adolescents at the completion of linear growth.
Drake WM - J Clin Endocrinol Metab - 01-APR-2003; 88(4): 1658-63
From NIH/NLM MEDLINE
NLM Citation ID:
12679453 (PubMed)
Comment:
- J Clin Endocrinol Metab. 2003 Sep;88(9):4506; author reply 4506-7
PubMed ID: 12970332
Full Source Title:
Journal of Clinical Endocrinology and Metabolism
Publication Type:
Clinical Trial; Journal Article; Randomized Controlled Trial
Language:
English
Author Affiliation:
Department of Endocrinology, St. Bartholomew's Hospital, London EC1A 7BE, United Kingdom. w.m.drake@qmul.ac.uk
Authors:
Drake WM; Carroll PV; Maher KT; Metcalfe KA; Camacho-Hübner C; Shaw NJ; Dunger DB; Cheetham TD; Savage MO; Monson JP
Abstract:
In many countries, treatment of childhood-onset HGH deficiency (HGH-D) with HGH ceases when linear growth is complete. Peak bone mass occurs several years after the completion of linear growth. Given that HGH has important anabolic actions on bone, discontinuation of HGH therapy at the completion of linear growth may have adverse consequences for the attainment of peak bone mass in adolescent HGH-D patients. In this United Kingdom multicenter study, 24 adolescents (13 males, mean age 17.0 +/- 1.4 yr, SD) with severe HGH-D were randomized to discontinue or continue HGH (0.35 IU/kg x wk) at the completion of linear growth. Whole body bone mineral content (BMC) and lumbar spine bone mineral density were assessed by dual-energy x-ray absorptiometry at baseline and then at 6-month intervals for 1 yr. Markers of bone remodeling (serum bone-specific alkaline phosphatase and urinary deoxypyridinoline) were measured at the same time points. In patients who continued GH (GH+), median BMC increased by 3.8% (interquartile range, 2.6, 5.9, P < 0.001) at 6 months; and by 6.0% (3.7-9.1, P < 0.001) at 12 months. In patients who discontinued GH (GH-) median BMC was unchanged at 6 and 12 months (+1.9%, -0.4-4.2, P = 0.9; and +2.4%, 0.4-4.9, P = 0.5, respectively, median, interquartile range). The differences in median change in BMC between the two groups at 6 and 12 months was marginally significant (P = 0.085 and 0.074, respectively). Mean lumbar spine bone mineral density increased by 4.7 (95% confidence interval, 1.0, 8.2) at 12 months in patients continuing GH (P = 0.01), but the mean change was not statistically significant change in patients who discontinued GH [+2.7% (95% confidence interval, -0.8, +6.2)]. These preliminary data suggest that, in adolescent patients with severe HGH-D, discontinuation of HGH at completion of growth may limit the attainment of peak bone mass in this patient group. This may predispose to clinically significant osteopenia in later adult life.
Major Subjects:
- Calcification, Physiologic
- Growth
- Human Growth Hormone / * administration & dosage / * deficiency / therapeutic use
Additional Subjects:
- Adolescent
- Adult
- Alkaline Phosphatase / blood
- Amino Acids / urine
- Biological Markers / analysis
- Body Height
- Bone Density
- Bone Remodeling
- Female
- Humans
- Insulin-Like Growth Factor I / analysis
- Male
- Research Support, Non-U.S. Gov't
Chemical Compound Name:
(Amino Acids); (Biological Markers); 12629-01-5(Human Growth Hormone); 67763-96-6(Insulin-Like Growth Factor I); 90032-33-0(deoxypyridinoline); EC 3.1.3.1(Alkaline Phosphatase)