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"Pain. Joints. Spine." 1 (21) 2016

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Growth hormone and bone

Authors: Payer J., Kužma M., Jackuliak P., Killinger Z. - Medical Faculty of Comenius University, 5th Department of Internal Medicine, University Hospital, Bratislava, Slovakia; Binkley N. - Department of Medicine, University of Wisconsin, Madison, Wisconsin, United States of America; Vaňuga P. - National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia

Categories: Rheumatology, Traumatology and orthopedics

Sections: Medical forums

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The article was published on p. 81

 

Introduction. Growth hormone deficiency (GHD) is associated with reduced bone mineral density (BMD). GH replacement has positive effect on BMD but the magnitude of this effect and its mechanism are debated. Thus, trabecular bone microarchitecture might play a role in increased fracture rate of GHD patients, but the effect of GH on trabecular bone score (TBS) was not well documented yet.

Objectives. Assessment of the effect of GH replacement on bone parameters, represented by BMD and TBS. 
Methods. Adult GHD (AO-GHD) and childhood onset GHD (CO-GHD) patients treated with GH using IGF-I normalization GH replacement regimen were prospectively followed during two years. Lumbar spine (L1–L4) and total hip (TH) BMD by DXA was assessed at baseline, month 12 and 24,. The trabecular bone score (TBS) derived from lumbar spine DXA by the iNsight® software was assessed in subset of study population at baseline, months 12 and 24. Bone turnover markers; osteocalcin and carboxy-terminal collagen crosslinks (CTx) were assessed at baseline and at months 3, 6, 12 and 24, respectively.
Results. In total, 147 GHD patients (age 35.1 yrs, 84 males/63 females, 43 of child onset-GHD/104 AO-GHD) were included. BMD of lumbar spine and femur increased significantly during the treatment (14% and 7% increase at two years, respectively; p < 0.0001). The TBS increased by 2.3 % (p = 0.035) and 3.1 % (p = 0.002) after the first and second year, respectively. A greater increase in TBS was observed in CO-GHD patients (+ 5.02 %, p = 0.05). A positive correlation between TBS, BMD, and osteocalcin was observed. 
Conclusions. GH supplementation leads to an increase of BMD with corresponding changes in bone turnover markers and changes in microarchitecture as assessed by trabecular bone score.   

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