Abstract
The effects of growth hormone (GH) replacement on bone mass and body composition in adult with GH deficiency (AGHD) are still debated with regard to their persistence in the long term. Moreover, the impact of the gender on the response to GH is controversial. Aim of this study was to evaluate the long-term effects of rhGH replacement on bone mass and body composition in a monocentric cohort of patients with AGHD. Data from 118 patients with AGHD (34.8 ± 14.4 years, 43 women and 75 men) treated with rhGH for a period of at least 3 years up to a maximum of 10 were retrospectively collected. Bone mineral density (BMD) at the lumbar spine, femur, and 1/3 radius, and total and truncular body composition were evaluated by dual-energy X-ray absorption (DXA) before and during treatment. Clinical and laboratory evaluations were performed before and during the treatment period on an annual basis. Lumbar spine BMD consistently increased in males, while it decreased in females after a transient improvement observed during the first 4 years of therapy. There were no significant changes in femoral and 1/3 radial BMD in either sexes. Lean mass significantly increased in both sexes, while fat mass only decreased in males. In AGHD patients long-term rhGH replacement therapy induces a positive effect with regard to bone mass and body composition. A sexual dimorphism in the response to treatment is evident, with males displaying a more favorable outcome.
Highlights
Untreated growth hormone deficiency (GHD) in adulthood is characterized by decreased bone mineral density (BMD) [1, 2] and body composition abnormalities such as increased fat mass, predominantly in the abdominal compartment [3], as well as a reduced lean mass at the expense of the muscles [4, 5]
The positive effect of replacement therapy with recombinant human GH on bone mass, body composition and cardiovascular functions has been consistently reported for treatment periods lasting up to fifteen years [16,17,18,19,20,21]
The results showed that in both genders GH replacement was able to activate bone remodeling, but bone mass outcome assessed by x-rays-absorptiometry (DXA) was only positive in males, even after controlling for potential confounders
Summary
Untreated growth hormone deficiency (GHD) in adulthood is characterized by decreased bone mineral density (BMD) [1, 2] and body composition abnormalities such as increased fat mass, predominantly in the abdominal (visceral) compartment [3], as well as a reduced lean mass at the expense of the muscles [4, 5]. It is generally assumed that GHD in adulthood may contribute to the increased fracture risk [6, 7] and the reduction of cardiac functionality observed in patients with panhypopituitarism [8]. The positive effect of replacement therapy with recombinant human GH (rhGH) on bone mass, body composition and cardiovascular functions has been consistently reported for treatment periods lasting up to fifteen years [16,17,18,19,20,21]. The effects were not constant among genders and over time
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