[Growth hormone and prevention in elderly patients--fantasy and reality]

Human growth hormone is one of the hormones used most frequently in the setting of so-called anti-aging strategies. To date, the preventive value of such a hormone replacement therapy in relatively healthy and well functioning middle aged persons is unknown. Although growth hormone leads to significant alterations in body composition and changes in serum cholesterol levels in patients with adult growth hormone deficiency, there are currently no data supporting the hypothesis that growth-hormone in non deficient persons prolongs life span or reduces morbidity. Aging is associated with a reduction of GH-secretion, serum levels of insulin like growth factor I (IGF-I) and alterations in body composition and function. Based on the many clinical similarities between aging and acquired growth hormone deficiency, several studies have assessed the effects of growth hormone administration in healthy aged women and men. Only a few studies have addressed functional outcomes in a more frail population. These studies suggest that a defined group of older individuals with functional limitation might benefit from GH as a strategy to prevent further functional decline and delay nursing home admission. Because of the lack of proof in frail patients, uncertain long-term effects and high treatment costs GH-administration in the aged should currently be restricted to research questions. Future studies should address the question whether growth hormone alone or in combination with established strategies, such as exercise or improvement in nutrition will serve as a measure to prevent functional decline in frail geriatric patient populations.