Fracture Risk in Postmenopausal Women With Osteoporosis May Improve With Growth Hormone Therapy
Individuals with growth hormone deficiency often have lower bone mineral density and are at increased risk for fracture.
A recent literature review and meta-analysis indicates that growth hormone therapy (GHT) may reduce the risk for fracture in patients with osteoporosis.
Individuals with growth hormone deficiency often have lower bone mineral density (BMD) and are at increased risk for fracture compared with people with normal levels of growth hormone. For this review, a total of 8 prospective controlled studies were analyzed to assess safety of growth hormone (GH) and its efficacy in osteoporosis. Outcomes included bone densitometry, biomarkers, and fracture risk. Studies were aggregated according to outcome, densitometric technique and end points, and anatomical site.
A total of 272 postmenopausal women (age 61 to 69) from 7 studies were included in the meta-analysis. Patients received GH daily, 3 times per week, or cyclically or placebo for 6 to 24 months in addition to treatment for osteoporosis — with the exception of one study.
GHT had no significant effect on BMD at the lumbar spine (weighted mean difference [WMD], −0.01; −0.04 to 0.02), femoral neck (WMD, 0; −0.03 to 0.04), or total hip (WMD, 0; −0.05 to 0.06). Bone mineral content was not affected by the GHT in these locations or in the distal forearm. GHT resulted in increased levels of the procollagen type I carboxy-terminal propeptide, a marker for bone formation (WMD, 14.03; 95% CI, 2.68-25.38; P =.02). In addition, GHT led to a 37% decrease in fracture risk compared with placebo (risk ratio, 0.63, 0.46-0.87; P =.004).
Adverse events were minor and mainly related to fluid retention, with symptoms generally subsiding after lowering the GH dose. Identified weaknesses included utilization of varying doses and regimens across studies and the possibility that cyclical dosing may have blunted densitometric end points. Although encouraging, the observed decrease in fracture risk stemmed from a single extension study.
The researchers concluded that, while fracture risk was reduced by the treatment, with minimal associated adverse events, the equivocal results on other end points indicated that “the impact of GH on bone quality is not clearly deﬁned and requires further investigation."
Barake M, Arabi A, Nakhoul N, et al. Effects of growth hormone therapy on bone density and fracture risk in age-related osteoporosis in the absence of growth hormone deficiency: a systematic review and meta-analysis (published online 13 October 2017). Endocrine. doi:10.1007/s12020-017-1440-0.