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Impact of Growth Hormone on Adult Bone Quality in Turner Syndrome: A HR-pQCT Study

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Abstract

Women with Turner syndrome (TS) are known to be at risk of osteoporosis. While childhood growth hormone (GH) treatment is common in TS, the impact of this therapy on bone health has been poorly understood. The objective of this study was to determine the influence of childhood GH treatment on adult bone quality in women with TS. 28 women aged 17–45 with confirmed TS (12 GH-treated) agreed to participate in this cross-sectional study. Dual X-ray absorptiometry (DXA) of lumbar spine, hip, and radius and high-resolution peripheral quantitative computed tomography (HR-pQCT) scans of the radius and tibia were used to determine standard morphological and micro-architectural parameters of bone health. Finite element (FE) analysis and polar moment of inertia (pMOI) were used to estimate bone strength. GH-treated subjects were +7.4 cm taller (95 % CI 2.5–12.3 cm, p = 0.005). DXA-determined areal BMD of hip, spine, and radius was similar between treatment groups. Both tibial and radial total bone areas were greater among GH-treated subjects (+20.4 and +21.2 % respectively, p < 0.05), while other micro-architectural results were not different between groups. pMOI was significantly greater among GH-treated subjects (radius +35.0 %, tibia +34.0 %, p < 0.05). Childhood GH treatment compared to no treatment in TS was associated with an increased height, larger bones, and greater pMOI, while no significant difference in DXA-derived BMD, HR-pQCT micro-architectural parameters, or FE-estimated bone strength was detected. The higher pMOI and greater bone size may confer benefit for fracture reduction in these GH-treated patients.

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Acknowledgements

The authors would like to acknowledge the hard work and dedication of Ms. Michelle Kan, Mr. Duncan Raymond, and Mr. Jan Owoc. The kind assistance from Mrs. Eileen Pyra was also greatly appreciated.

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Authors and Affiliations

  1. Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada

    Munier A. Nour

  2. Division of Pediatric Endocrinology and Metabolism, University of Calgary, Calgary, AB, Canada

    Munier A. Nour, Rebecca J. Perry & David K. Stephure

  3. Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Lauren A. Burt, Rebecca J. Perry, David K. Stephure, David A. Hanley & Steven K. Boyd

  4. Department of Radiology, University of Calgary, Calgary, AB, Canada

    Lauren A. Burt & Steven K. Boyd

  5. McCaig Institute for Bone and Joint Health, University of Calgary, Room HRIC 3AC64, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada

    Steven K. Boyd

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  1. Munier A. Nour
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Correspondence to Steven K. Boyd.

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Conflicts of Interest

Munier A. Nour, Lauren A. Burt, Rebecca J. Perry, David K. Stephure, David A. Hanley, and Steven K. Boyd declare that they have no conflict of interest.

Disclosures

Dr. Burt, Dr. Boyd, and Dr. Perry have nothing to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Funding

Dr. Nour and Dr. Hanley report grants from Alberta Children’s Hospital Research Institute (ACHRI), Canadian Pediatric Endocrine Group (CPEG), grants from Osteoporosis Canada, and Canadian Society of Endocrinology and Metabolism (CSEM), during the conduct of the study. Dr. Stephure reports grants from Alberta Children’s Hospital Research Institute (ACHRI) and Eli Lilly Canada Inc, during the conduct of the study.

Additional information

Alberta Children’s Hospital Research Institute (ACHRI); Canadian Pediatric Endocrine Group (CPEG); Canadian Society of Endocrinology and Metabolism (CSEM); Osteoporosis Canada.

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Nour, M.A., Burt, L.A., Perry, R.J. et al. Impact of Growth Hormone on Adult Bone Quality in Turner Syndrome: A HR-pQCT Study. Calcif Tissue Int 98, 49–59 (2016). https://doi.org/10.1007/s00223-015-0064-8

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  • DOI: https://doi.org/10.1007/s00223-015-0064-8

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