Abstract
ContextAdult growth hormone deficiency (AGHD) is characterized by low bone density and increased risk of fracture. Bone microarchitecture is insufficiently evaluated in patients with childhood-onset AGHD (CO AGHD).ObjectiveTo assess volumetric bone density (vBMD) and bone microarchitecture in CO AGHD in early adulthood after cessation of recombinant growth hormone (rhGH) treatment.Design and subjectsCase–control study in a major academic medical center in Beijing, including 20 young male adults with CO AGHD and 30 age- and weight-matched non-athletic healthy men. High-resolution peripheral quantitative computerized tomography (HR-pQCT) of distal radius and tibia was performed.OutcomesThe main outcomes were vBMD and morphometry parameters from HR-pQCT.ResultsCompared with healthy controls, CO AGHD group had significantly decreased insulin-like growth factor 1 (IGF-1) level and IGF-1 SDS (P < 0.001). β-CTX and alkaline phosphatase levels in CO AGHD group were significantly increased (P < 0.001). CO AGHD group had significantly decreased total vBMD, cortical vBMD, trabecular vBMD, cortical area, cortical thickness as well as trabecular thickness and trabecular bone volume fraction of both tibia and radius (P < 0.001). CO AGHD patients had an 8.4 kg decrease in grip strength and a significant decrease in creatinine levels (P = 0.001). At both tibia and radius, by finite element analysis, bone stiffness and failure load of the CO AGHD patients were significantly decreased (P < 0.001). After adjusting for age, BMI and serum levels of testosterone and free thyroxin, serum IGF-1 level was a positive predictor for total vBMD, cortical vBMD, cortical area, trabecular vBMD, bone stiffness and failure load of both tibia and distal radius in all subjects.ConclusionsYoung adult male patients with childhood-onset adult growth hormone deficiency who are no longer receiving growth hormone replacement have prominently impaired volumetric bone density and bone microarchitecture and lower estimated bone strength.
Highlights
Adult growth hormone deficiency (AGHD) is an uncommon but debilitating disorder characterized by low bone mineral density, sarcopenia, increased risk of metabolic syndrome and decreased quality of life [1]
As for the radius, after adjusting for age, BMI and serum levels of testosterone and FT4, serum insulin-like growth factor 1 (IGF-1) level was a positive predictor for total volumetric bone mineral density (vBMD) (β = 0.4781, P < 0.001), cortical vBMD (β = 0.6503, P < 0.001), cortical area (β = 0.1096, P < 0.001), cortical thickness (β = 0.0019, P < 0.001), trabecular vBMD (β = 0.1565, P = 0.008), trabecular thickness (β = 0.0001, P < 0.001), trabecular bone volume fraction (β = 0.0003, P = 0.003), bone stiffness (β = 161.25, P < 0.001) and failure load (β = 8.49, P < 0.001)
We focused on vBMD, bone microarchitecture and estimated bone strength of young male adult with childhood-onset AGHD (CO AGHD) and compared with age-matched controls
Summary
Adult growth hormone deficiency (AGHD) is an uncommon but debilitating disorder characterized by low bone mineral density, sarcopenia, increased risk of metabolic syndrome and decreased quality of life [1]. Since recombinant human growth hormone (rhGH) became available in 1985, it was reported to be effective in improving metabolic parameters, bone mineral density and quality of life in AGHD patients [2]. Dual-energy X-ray absorptiometry (DXA) at the hip and lumbar spine is widely used to evaluate skeletal situation in AGHD patients before and after rhGH replacement therapy [3, 4, 5]. DXA only evaluates 2D areal bone mineral density (aBMD) and does not provide details of microarchitecture of cortical and cancellous bones. No bone microarchitecture deficiency was reported in this series of patients
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