Effect of gonadal status on baseline and after rhGH treatment prevalence of spinal deformities in adult patients with growth hormone deficiency (GHD)

Gherardo Mazziotti; Antonio Bianchi; Stefania Bonadonna; Monica Nuzzo; Vincenzo Cimino; Alessandra Fusco; Laura De Marinis; Andrea Giustina

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Endocrine Abstracts (2007) 14 OC2.5

ECE2007 Oral Communications Bone & calcium metabolism (7 abstracts)

Effect of gonadal status on baseline and after rhGH treatment prevalence of spinal deformities in adult patients with growth hormone deficiency (GHD)

Gherardo Mazziotti ¹ , Antonio Bianchi ² , Stefania Bonadonna ¹ , Monica Nuzzo ¹ , Vincenzo Cimino ² , Alessandra Fusco ² , Laura De Marinis ² & Andrea Giustina ¹

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¹Department of Internal Medicine, University of Brescia, Brescia, Italy; ²Department of Endocrinology, Catholic University, Rome, Italy.

Adult GHD patients may have reduced BMD, which is thought to be reverted by long-term rhGH replacement therapy. We have recently reported high prevalence of vertebral osteoporotic deformities in untreated adult GHD patients. Gonadal status is the main determinant of bone loss in patients with primary form of osteoporosis.

In this cross-sectional study, we investigated whether the prevalence and degree of spinal deformities in adults with treated or untreated GHD was in relation to the gonadal status of the patients. Seventy-six adult hypopituitary patients (46 males and 30 females; mean age 46.8 years, range: 16–81) with severe GHD were evaluated for BMD (dual-energy X-ray absorptiometry) and vertebral deformities (T4-L5 quantitative morphometric analysis according to Genant score). At the study entry, 41 patients were eugonadic (21 patients with preserved gonadal function and 20 patients in adequate replacement therapy), whereas 35 patients were hypogonadic.

Vertebral deformities (>20%) were found in 48 patients (63.2%), with higher prevalence in untreated (42 cases) vs. treated patients (24 cases) [76.9% vs. 33.3%; P<0.001]. Eugonadic and hypogonadic patients with untreated GHD showed comparable fracture rate (78.6% vs. 75.0%; P=0.8). rhGH replacement therapy was accompanied by a significant decrease in fracture rate as compared to untreated patients [eugonadic: 35.3% vs. 75.0%, P=0.01; hypogonadic: 28.6% vs. 78.6%, P=0.01]. Eugonadic patients had slightly but significantly higher BMD than hypogonadic patients. Multivariate logistic regression analysis demonstrated that no treatment with rhGH was the only factor significantly influencing the occurrence of spinal deformities in adult GHD patients (odds ratio: 5.8, CI 95% 1.9–18.1) whereas no significant correlation was found with gonadal status, BMD, sex and age.

Gonadal status of adult patients with GHD may be not critical for the prevalence of vertebral radiological deformities which is instead mainly affected by the replacement treatment with rhGH.