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Bone density and body composition in chronic renal failure: effects of growth hormone treatment
I M van der Sluis1, A M Boot, J Nauta
1Department of Pediatrics, Division of Endocrinology and Nephrology, Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands. vandesluis@alkg.azr.nl
Insights
Growth hormone treatment improved bone mineral density in the axial skeleton and overall growth in children with chronic renal failure (CRF). Bone mineral density did not differ between children with CRF and healthy children.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Metabolic Bone Disease
Background:
- Chronic renal failure (CRF) commonly leads to metabolic bone disease and growth retardation in children.
- Assessing bone mineral density (BMD), bone metabolism, body composition, and growth is crucial in pediatric CRF.
- The impact of growth hormone treatment (GHRx) on these parameters requires further investigation.
Purpose of the Study:
- To evaluate BMD, bone metabolism, body composition, and growth in children with CRF.
- To assess the effects of growth hormone treatment (GHRx) on these variables in prepubertal children with CRF and growth retardation.
Main Methods:
- Thirty-three prepubertal children with CRF were studied, with 18 receiving growth hormone treatment (GHRx) for 2 years.
- Dual-energy X-ray absorptiometry was used every 6 months to measure BMD (lumbar spine, total body) and body composition.
- Biochemical markers of bone turnover were assessed throughout the study.
Main Results:
- Mean BMD in children with CRF was comparable to normal controls.
- GHRx led to significant increases in lumbar spine BMD, bone mineral apparent density, and height Standard Deviation Score (SDS).
- Lean body mass and alkaline phosphatase increased in the GHRx group; other bone turnover markers increased in both groups but did not correlate with BMD changes.
Conclusions:
- BMD in children with CRF was not significantly different from healthy children, possibly due to adequate treatment or short disease duration.
- Growth hormone treatment (GHRx) improved axial skeletal BMD and linear growth in children with CRF and growth retardation.
- GHRx demonstrated a favorable safety profile in this pediatric CRF cohort.
Abstract:
Metabolic bone disease and growth retardation are common complications of chronic renal failure (CRF). We evaluated bone mineral density (BMD), bone metabolism, body composition and growth in children with CRF, and the effect of growth hormone treatment (GHRx) on these variables. Thirty-three prepubertal patients with CRF were enrolled including 18 children with growth retardation, who were treated with growth hormone for 2 years. Every 6 months, BMD of lumbar spine and total body, and body composition were measured by dual-energy X-ray absorptiometry. Biochemical parameters of bone turnover were assessed. Mean BMD of children with CRF did not differ from normal. During GHRx, BMD and bone mineral apparent density of lumbar spine and height SDS increased, whereas BMD of total body did not change. Lean body mass increased in the GH group. Alkaline phosphatase increased significantly in the GH group only. The other biochemical parameters of bone turnover increased in both groups, none of them correlated with the changes in BMD. No serious adverse effects of GHRx were reported. In conclusion, BMD of children with CRF did not differ from healthy children. Adequate treatment with alpha-calcidiol or the short duration of renal failure may have attributed to the absence of osteopenia in our patients. BMD of the axial skeleton and growth improved with GHRx.