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Enhanced effect of zinc and calcium supplementation on bone status in growth hormone-deficient children treated with growth hormone: a pilot randomized controlled trial

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Abstract

Reduced bone mineral content in growth hormone-deficient children (GHD) has been reported. Calcium, zinc, and vitamin D play an important role in bone formation. Hence, the aim of this pilot randomized controlled study was to evaluate the effect of calcium, vitamin D, and zinc supplementation in prepubertal GHD children treated with GH on bone health parameters. After 1 year of treatment with GH (20 mg/m2/week), 31 GHD (mean age 8.7 ± 2.8 years, 18 boys) prepubertal children were randomised to receive calcium (500 mg/day) and vitamin D (60,000 IU/3 months) [Group A] or a similar supplement of calcium, vitamin D, and zinc (as per Indian Recommended Allowance) [Group B] along with GH therapy for the next 12 months. The two groups were similar in anthropometric and body composition parameters at baseline (p > 0.1). After 1 year of GH therapy, height-adjusted % gain was similar in both groups, 48 % in bone mineral content (BMC) and 45 % in bone area (BA). Height-adjusted % increase in BMC was significantly (p < 0.05) higher in the second year than in the first in both the groups. This % increase in BMC and BA was greater in Group B (51 and 36 % respectively) than in Group A (49 and 34 %), although marginally (p < 0.05). Supplementation of calcium and vitamin D along with GH therapy in GHD Indian children has the potential for enhancing bone mass accrual; this effect was further enhanced through the addition of zinc supplement.

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Abbreviations

GH:

Growth hormone

GHD:

Growth hormone deficient

GHT:

Growth hormone therapy

LBM:

Lean body mass

BMC:

Bone mineral content

BA:

Bone area

RDA:

Recommended dietary allowance

DXA:

Dual energy X-ray absorptiometry

iCa:

Ionized calcium

iPTH:

Intact parathyroid hormone

25 OHD:

25, Di hydroxy cholecalciferol

Zn:

Zinc

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Acknowledgments

We are grateful to the children and their parents for their extended support throughout the study period. We are grateful to Ms. Shamim Momin and Ms. Deepa Pillay for their help in data collection. We also thank the State Public Health Laboratory and Dr. Uma Divate, Director, HCJMRI, for support.

Conflict of interest:

None Declared.

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Authors and Affiliations

  1. Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India

    Veena Ekbote, Anuradha Khadilkar, Shashi Chiplonkar & Vaman Khadilkar

  2. Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, M13 9WL, UK

    Zulf Mughal

  3. Growth and Paediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Lower Basement, Jehangir Hospital, 32, Sassoon Road, Pune, 411 001, India

    Anuradha Khadilkar

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  1. Veena Ekbote
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  2. Anuradha Khadilkar
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  5. Vaman Khadilkar
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Correspondence to Anuradha Khadilkar.

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Ekbote, V., Khadilkar, A., Chiplonkar, S. et al. Enhanced effect of zinc and calcium supplementation on bone status in growth hormone-deficient children treated with growth hormone: a pilot randomized controlled trial. Endocrine 43, 686–695 (2013). https://doi.org/10.1007/s12020-012-9847-0

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