Does growth hormone therapy in adult patients with growth hormone deficiency protect against bone loss?

Fracture incidence is increased in growth hormone deficiency (GHD). However, the efficacy of growth hormone (GH) in the prevention of fractures in GHD is not documented. GH is important to attain normal peak bone mass; it increases bone mass in children and adolescents, but is less important with increasing age and is insignificant above the age of 55-60 years old. Placebo-controlled trials of 12 months' duration have failed to improve bone mass density, while uncontrolled studies have suggested that GH treatment for 2-4 years may increase bone mass by 0.5 of a standard deviation in adults. Given the current high price of GH treatment, however, routine substitution with the intention to decrease fracture incidence in adult GHD patients is not likely to be cost effective. GH substitution should probably be extended until peak bone mass has been achieved, and repeated dual energy X-ray scan measurements with intervals of 1-2 years could be helpful in deciding when to stop treatment. (C) 1998 Churchill Livingstone.