Skip to main content
SpringerLink
Log in

Effect of gonadal status on bone mineral density and radiological spinal deformities in adult patients with growth hormone deficiency

  • Published:
Pituitary Aims and scope Submit manuscript

Abstract

Growth hormone deficiency (GHD) in adult patients is associated with marked decrease in bone turnover, low bone mass and high risk of clinical and subclinical fractures. We investigated whether the prevalence of spinal deformities in adults with GHD was related to the gonadal status of patients. A total of 89 adult hypopituitary patients with severe GHD were evaluated for bone mineral density (BMD) and vertebral deformities (quantitative morphometric analysis). At the study entry, 54 patients were eugonadic whereas 35 patients were hypogonadic without replacement treatment. Radiological spinal deformities were found in 55 patients (61.8%) with higher prevalence in untreated (56 cases) versus treated (33 cases) GHD patients. Eugonadic and hypogonadic patients showed no significant difference in spinal deformities although T-score was significantly lower in hypogonadic as compared with eugonadic patients. Gonadal function was not correlated with the occurrence of spinal deformities which was instead inversely correlated with rhGH treatment. In conclusion, gonadal status may influence BMD in adult patients with GHD without affecting the risk to develop vertebral deformities. Conversely, rhGH replacement treatment seems to be the only factor influencing the risk to develop vertebral deformities in adult GHD patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ohlsson C, Bengtsson BA, Isaksson OGP, Andreassen TT, Slootweg MC (1998) Growth hormone and bone. Endocr Rev 19:55–79

    Article  PubMed  CAS  Google Scholar 

  2. de Boer H, Block GJ, Van der Veen EA (1995) Clinical aspects of growth hormone deficiency in adults. Endocr Rev 16:63–86

    Article  PubMed  Google Scholar 

  3. Doga M, Bonadonna S, Gola M, Mazziotti G, Giustina A (2006) Growth hormone deficiency in adult. Pituitary 9:305–311

    Article  PubMed  CAS  Google Scholar 

  4. Wuster C (2000) Fracture rates in patients with growth hormone deficiency. Horm Res 54:31–35

    Article  PubMed  CAS  Google Scholar 

  5. Rosen T, Wilhelmsen L, Landin-Wilhelmsen K, Lappas G, Bengtsson BA (1997) Increased fracture frequency in adult patients with hypopituitarism and GH deficiency. Eur J Endocrinol 137:240–245

    Article  PubMed  CAS  Google Scholar 

  6. Wuster C, Abs R, Bengtsson BA, Bennmarker H, Feldt-Rasmussen U, Hernberg-Stahl E, Monson JP, Westberg B, Wilton P, KIMS Study Group and the KIMS International Board (2001) Pharmacia & upjohn international metabolic database. The influence of growth hormone deficiency, growth hormone replacement therapy, and other aspects of hypopituitarism on fracture rate and bone mineral density. J Bone Miner Res 16:398–405

    Article  PubMed  CAS  Google Scholar 

  7. Mazziotti G, Bianchi A, Bonadonna S, Nuzzo M, Cimino V, Fusco A, De Marinis L, Giustina A (2006) Increased prevalence of radiological spinal deformities in adult patients with GH deficiency: influence of GH replacement therapy. J Bone Miner Res 21:520–528

    Article  PubMed  CAS  Google Scholar 

  8. Doga M, Bonadonna S, Gola M, Mazziotti G, Nuzzo M, Giustina A (2005) GH deficiency in the adult and bone. J Endocrinol Invest 28(8 Suppl):18–23

    PubMed  CAS  Google Scholar 

  9. Vandeweghe M, Taelman P, Kaufman JA (1993) Short and long-term effects of growth hormone treatment on bone turnover and bone mineral content in adult growth hormone-deficient males. Clin Endocrinol 39:409–415

    CAS  Google Scholar 

  10. Kann P, Piepkorn B, Schehler B, Andreas J, Lotz J, Prellwitz W, Beyer J (1998) Effect of long-term treatment with GH on bone metabolism, bone mineral density and bone elasticity in GH-deficient adults. Clin Endocrinol 48:561–568

    Article  CAS  Google Scholar 

  11. Davidson P, Milne R, Chase D, Cooper C (2004) Growth hormone replacement in adults and bone mineral density: a systematic review and meta-analysis. Clin Endocrinol 60:92–98

    Article  CAS  Google Scholar 

  12. Nordin BE, Aaron J, Speed R, Crilly RG (1981) Bone formation and resorption as the determinants of trabecular bone volume in postmenopausal osteoporosis. Lancet 8:277–279

    Article  Google Scholar 

  13. Hitz MF, Jensen JE, Eskildsen PC (2006) Bone mineral density in patients with growth hormone deficiency: does a gender difference exist? Clin Endocrinol 65:783–791

    Article  CAS  Google Scholar 

  14. Bengtsson BA, Abs R, Bennmarker H, Monson JP, Feldt-Rasmussen U, Hernberg-Stahl E, Westberg B, Wilton P, Wuster C, KIMS Study Group and the KIMS International Board (1999) The effects of treatment and the individual responsiveness to growth hormone (GH) replacement therapy in 665 GH-deficient adults. J Clin Endocrinol Metab 84:3929–3935

    Article  PubMed  CAS  Google Scholar 

  15. Drake WM, Rodriguez-Arnao J, Weaver JU, James IT, Coyte D, Spector TD, Besser GM, Monson JP (2001) The influence of gender on the short and long-term effects of growth hormone replacement on bone metabolism and bone mineral density in hypopituitary adults: a 5-year study. Clin Endocrinol 54:525–532

    Article  CAS  Google Scholar 

  16. Grigoryan M, Guermazi A, Roemer FW, Delmas PD, Genant HK (2003) Recognizing and reporting osteoporotic vertebral fractures. Eur Spine J 12:S104–112

    Article  PubMed  Google Scholar 

  17. Reeve J, Lunt M, Felsenberg D, Silman AJ, Scheidt-Nave C, Poor G, Gennari C, Weber K, Lorenc R, Masaryk P, Cannata JB, Dequeker J, Reid DM, Pols HA, Benevolenskaya LI, Stepan JJ, Miazgowski T, Bhalla A, Bruges Armas J, Eastell R, Lopes-Vaz A, Lyritis G, Jajic I, Woolf AD, Banzer D, Reisinger W, Todd CJ, Felsch B, Havelka S, Hoszowski K, Janott J, Johnell O, Raspe HH, Yershova OB, Kanis JA, Armbrecht G, Finn JD, Gowin W, O’Neill TW, European Prospective Osteoporosis Study Group (2003) Determinants of the size of incident vertebral deformities in European men and women in the sixth to ninth decades of age: the European prospective osteoporosis study. J Bone Min Res 18:1664–1673

    Article  CAS  Google Scholar 

  18. Siris ES, Genant HK, Laster AJ, Chen P, Misurski DA, Krege JH (2007) Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporos Int 18:761–770

    Article  PubMed  CAS  Google Scholar 

  19. Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Shalet SM, Vance ML (2006) Evaluation and treatment of adult growth hormone deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 91:1621–1634

    Article  PubMed  CAS  Google Scholar 

  20. World Health Organization, Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical Report Series 1994, 843, Geneva, WHO

  21. Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D (1997) Guidelines for diagnosis and management of osteoporosis. The european foundation for osteoporosis and bone disease. Osteoporos Int 7:390–406

    Article  PubMed  CAS  Google Scholar 

  22. Genant HK, Jergas M, Palermo L, Nevitt M, Valentin RS, Black D, Cummings SR (1996) Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in the osteoporosis. The study of osteoporotic fractures research group. J Bone Min Res 11:984–996

    Article  CAS  Google Scholar 

  23. Lindsay R, Hart DM, Clark DM (1984) The minimum effective dose of estrogen for prevention of postmenopausal bone loss. Obstet Gynecol 63:759–63

    PubMed  CAS  Google Scholar 

  24. Wronski TJ, Cintron M, Doherty AL, Dann LM (1988) Estrogen treatment prevents osteopenia and depresses bone turnover in ovariectomized rats. Endocrinology 123:681–686

    Article  PubMed  CAS  Google Scholar 

  25. Kassem M, Okazaki R, Harris SA, Spelsberg TC, Conover CA, Riggs BL (1998) Estrogen effects on insulin-like growth factor gene expression in a human osteoblastic cell line with high levels of estrogen receptor. Calcif Tissue Int 62:60–66

    Article  PubMed  CAS  Google Scholar 

  26. Giustina A, Veldhuis JD (1998) Pathophysiology of the neuroregulation of growth hormone secretion in experimental animals and the human. Endocr Rev 19:717–797

    Article  PubMed  CAS  Google Scholar 

  27. Mazziotti G, Angeli A, Bilezikian JP, Canalis E, Giustina A (2006) Glucocorticoid-induced osteoporosis: an update. Trends Endocrinol Metab 7:144–149

    Article  CAS  Google Scholar 

  28. Khan AA, Hanley DA, Bilezikian JP, Binkley N, Brown JP, Hodsman AB, Josse RG, Kendler DL, Lewiecki EM, Miller PD, Olszynski WP, Petak SM, Syed ZA, Theriault D, Watts NB, Canadian Panel of the International Society for Clinical Densitometry (2006) Standards for performing DXA in individuals with secondary causes of osteoporosis. J Clin Densitom 9:47–57

    Article  PubMed  Google Scholar 

  29. Cefalu CA (2004) Is bone mineral density predictive of fracture risk reduction? Curr Med Res Opin 20:341–349

    Article  PubMed  Google Scholar 

  30. Olesik A, Ott SM, Vedi S, Bravenboer N, Compston J, Lips P (2000) Bone structure in patients with low bone mineral density with or without vertebral fractures. J Bone Min Res 15:1368–1375

    Article  Google Scholar 

  31. Parfitt AM (1992) Implications of architecture for the pathogenesis and prevention of vertebral fracture. Bone 13:S41–44

    Article  PubMed  Google Scholar 

  32. Evans BA, Warner JT, Elford C, Evans SL, Laib A, Bains RK, Gregory JW, Wells T (2003) Morphological determinants of femoral strength in growth hormone-deficient transgenic growth-retarded (Tgr) rats. J Bone Miner Res 18:1308–1316

    Article  PubMed  CAS  Google Scholar 

  33. Lange M, Qvortrup K, Lander Svendsen O, Flyvbjerg A, Nowak J, Petersen MM, Olgaard K, Feldt-Rasmussen U (2004) Abnormal bone collagen morphology and decreased bone strength in growth hormone-deficient rats. Bone 35:178–185

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

Study partially supported by EULO, MIUR, Centro Ricerca Sull’Osteoporosi-University of Brescia. The authors are indebted to G. Milani for technical help.

Author information

Authors and Affiliations

  1. Endocrine Section, Department of Internal Medicine, University of Brescia, 2 Medicina-Spedali Civili, 25125, Brescia, Italy

    Gherardo Mazziotti, Stefania Bonadonna, Paola Martini & Andrea Giustina

  2. Endocrinology, Catholic University, Rome, Italy

    Antonio Bianchi, Vincenzo Cimino, Alessandra Fusco & Laura De Marinis

Authors
  1. Gherardo Mazziotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonio Bianchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vincenzo Cimino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefania Bonadonna
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paola Martini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alessandra Fusco
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Laura De Marinis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andrea Giustina
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrea Giustina.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mazziotti, G., Bianchi, A., Cimino, V. et al. Effect of gonadal status on bone mineral density and radiological spinal deformities in adult patients with growth hormone deficiency. Pituitary 11, 55–61 (2008). https://doi.org/10.1007/s11102-007-0069-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11102-007-0069-z

Keywords

Search

Navigation