Abstract
Objectives
The aim of our study was the longitudinal assessment of bone health index (BHI) in short-statured children during growth hormone (GH) treatment to estimate changes in their bone health.
Methods
256 short-statured children (isolated GH deficiency (IGHD) n=121, multiple pituitary hormone deficiency (MPHD) n=49, intrauterine growth retardation (small for gestational age (SGA)) n=52, SHOX (short stature homeobox gene) deficiency n=9, Ullrich Turner syndrome (UTS) n=25) who started with GH between 2010 and 2018 were included. Annual bone ages (Greulich and Pyle, GP) and BHI were, retrospectively, analysed in consecutive radiographs of the left hand (BoneXpert software) from GH therapy start (T0) up to 10 years (T10) thereafter, with T max indicating the individual time point of the last available radiograph. The results are presented as the median (25 %/75 % interquartile ranges, IQR) and statistical analyses were performed using non-parametric tests as appropriate.
Results
The BHI standard deviation scores (SDS) were reduced (−0.97, −1.8/−0.3) as bone ages were retarded (−1.6 years, −2.31/−0.97) in all patients before start of GH and were significantly lower in patients with growth hormone deficiency (GHD) (−1.04, −1.85/−0.56; n=170) compared to non-GHD patients (−0.79, −1.56/−0.01; n=86; p=0.022). BHI SDS increased to −0.17 (−1/0.58) after 1 year of GH (T1, 0.5–1.49, p<0.001) and to −0.20 (−1/−0.50, p<0.001) after 5.3 years (T max, 3.45/7.25).
Conclusions
BHI SDS are reduced in treatment-naive short-statured children regardless of their GH status, increase initially with GH treatment while plateauing thereafter, suggesting sustained improved bone health.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. LH, DC and MB planned the study, wrote study protocol, conducted study and collected data. LH evaluated the data, performed statistical analyses and created the graphs. LH, DC, MR, JPS and MB wrote the manuscript and interpreted the final results. All authors performed proof reading of the final version of this manuscript. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
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Competing interests: Authors state no competing of interest.
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Informed consent: Not applicable. The Ethics Committee of University Hospital Heidelberg approved the study (S-029/2019) and decided that written consents of study participants were not required. The identification of personal information was not necessary for scientific reasons. All data were used pseudonymized.
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Ethical approval: The Ethics Committee of University Hospital Heidelberg approved the study (S-029/2019). Written consents of study participants were not required. Study was conducted according to the recommendations of the Declaration of Helsinki.
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Data availability: The data is available from the corresponding author (LH) upon reasonable request.
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Definition of research data: Primary data.
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