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Fracture incidence in GH-deficient patients on complete hormone replacement including GH

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Author

  • Helene Holmer
  • Johan Svensson
  • Lars Rylander
  • Gudmundur Johannsson
  • Thord Rosen
  • Bengt-Ake Bengtsson
  • Marja Thoren
  • Charlotte Hoybye
  • Marie Degerblad
  • Margareta Bramnert
  • Erik Haegg
  • Britt Eden Engstroem
  • Bertil Ekman
  • Karl-Goeran Thorngren
  • Lars Hagmar
  • Eva-Marie Erfurth
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Summary, in English

Fracture risk in GHD patients is not definitely established. Studying fracture incidence in 832 patients on GH therapy and 2581 matched population controls, we recorded a doubled fracture risk in CO GHD women, but a significantly lower fracture risk in AO GHD men. Introduction: The objective of this study was to evaluate fracture incidence in patients with confirmed growth hormone deficiency (GHD) on replacement therapy (including growth hormone [GH]) compared with population controls, while also taking potential Confounders and effect modifiers into account. Materials and Methods: Eight hundred thirty-two patients with GHD and 2581 matched population controls answered a questionnaire about fractures and other background information. Incidence rate ratio (IRR) and 95% CI for first fracture were estimated. The median time on GH therapy for childhood onset (CO) GHD men and women was 15 and 12 yr, respectively, and 6 and 5 yr for adult onset (AO) GHD men and women, respectively. Results: A more than doubled risk (IRR, 2.29; 95 % CI 1.23-4.28) for nonosteoporotic fractures was recorded in women with CO GHD, whereas no risk increase was observed among CO GHD men (IRR, 0.61) and AO GHD women (IRR, 1.08). A significantly decreased incidence of fractures (IRR, 0.54; 95% C1, 0.34-0.86) was recorded in AO GHD men. Conclusions: Increased fracture risk in CO GHD women can most likely be explained by interaction between oral estrogen and the GH-IGF-I axis. The adequate substitution rate of testosterone (90%) and GH (94%) may have resulted in significantly lower fracture risk in AO GHD men.

Publishing year

2007

Language

English

Pages

1842-1850

Publication/Series

Journal of Bone and Mineral Research

Volume

22

Issue

12

Document type

Journal article

Publisher

Wiley-Blackwell

Topic

  • Endocrinology and Diabetes
  • Environmental Health and Occupational Health

Keywords

  • growth hormone therapy
  • hormone deficiency
  • growth
  • pituitary deficiency
  • population study
  • fracture incidence

Status

Published

ISBN/ISSN/Other

  • ISSN: 1523-4681