Trabecular Bone Score Change Differs with Regard to 25(OH)D Levels in Patients Treated for Adult-Onset Growth Hormone Deficiency |
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| Institution: | 1. From the Comenius University Faculty of Medicine, 5th Department of Internal Medicine, University Hospital, Bratislava, Slovakia;2. Department of Medicine, University of Wisconsin, Madison, Wisconsin;3. National Institute of Endocrinology and Diabetology, L''ubochňa, Slovakia.;1. From Carol Davila University of Medicine and Pharmacy, Department of Endocrinology, Bucharest, Romania;2. C.I. Parhon Institute of Endocrinology, Department of Pituitary and Neuroendocrine Disorders, Bucharest, Romania.;1. Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA;2. Department of Pediatric Nephrology, Clinic for Children''s Diseases, University Children''s Hospital, Medical School of Skopje, Skopje, Macedonia;3. Department of Endocrinology, Children''s Hospital of Michigan, Detroit, MI 48201, USA;4. Pediatric Endocrinology, Trakya University, Faculty of Medicine, Edirne, Turkey;5. Department of Pediatrics, University Children''s Medical Institute, National University Hospital, Singapore;1. Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan;2. Division of Diabetes and Endocrinology, Kobe University Hospital, Japan;3. Department of Nutrition, Kobe University Hospital, Japan |
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| Abstract: | Objective: Vitamin D is important in bone health. However, potential relationships of concomitant vitamin D deficiency with growth hormone deficiency (GHD) and the possibility that vitamin D inadequacy may alter the skeletal effects of growth hormone (GH) replacement therapy have not been adequately evaluated.Methods: A prospective study was conducted in adult-onset GHD patients treated with recombinant human GH (rhGH) for 2 years. Trabecular bone score (TBS), lumbar spine (LS) bone mineral density (BMD), total hip (TH) BMD, and 25-hydroxyvitamin D (25(OH)D) levels were assessed at baseline and 24 months. The study cohort was divided based on 25(OH)D levels into 2 groups with the cutoff defined as the 50th percentile at each follow-up time point.Results: Fifty-seven patients (29 males/28 females, mean age 34.4 years) were studied. After 24 months of GH replacement, LS BMD increased by 7.6% and TH BMD increased by 4.5% (both P<.05), with no difference according to 25(OH)D levels. TBS increased (+1.39 ± 3.6%) in those whose 25(OH)D was above the 50th percentile but decreased (-1.36 ± 5.6%, P<.05) in the cohort below the 50th percentile of 25(OH)D. Positive correlations were observed between baseline levels of IGF-1 and 25(OH)D (R = 0.37, P<.001) and between 24-month 25(OH)D and TBS (R = 0.25, P<.05).Conclusion: A differential effect of GH on TBS change was observed; TBS increased only in the cohort with 25(OH)D above the 50th percentile. Vitamin D sufficiency may be required to obtain optimal effects of GH treatment on bone quality, as assessed by TBS, in GHD adults.Abbreviations:AO-GHD = adult-onset GHDBMD = bone mineral densityBMI = body mass indexCa = calciumCTx = carboxyterminal collagen crosslinksCV = coefficient of variationDXA = dual energy X-ray absorptiometryECLIA = enzyme-labeled chemiluminescent immunometric assayGH = growth hormoneGHD = growth hormone deficiencyIGF-1 = insulin-like growth factor 1LS BMD = lumbar spine BMDOC = osteocalcin25(OH)D = 25-hydroxyvitamin DP = phosphorusPTH = parathyroid hormonerhGH = recombinant human GHTBS = trabecular bone scoreTH BMD = total hip BMD |
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