The somatopause: an indication for growth hormone therapy?

Human aging causes adverse changes in body composition, a fall in bone mineral density, a deterioration in physical performance, a worsening cardiovascular risk profile, and increased morbidity and mortality. In addition, growth hormone (GH) secretion and serum insulin-like growth factor (IGF)-I levels fall. GH deficiency in adults causes similar changes to those observed with aging, which has led to the suggestion that the elderly are GH deficient and would benefit from GH treatment. Randomized controlled studies have demonstrated modest benefits when GH treatment has been used alone or in combination with exercise or sex steroids. GH treatment in adults over 60 years of age is associated with a high incidence of adverse effects, particularly peripheral edema, arthralgia, and carpal tunnel syndrome. Studies to date have been for a maximum of 12 months, so long-term safety data are not available in this setting. There are particular concerns over the links between the GH-IGF-I axis and the development of cancer in the normal population. Long-term studies are required to determine the efficacy and safety of GH treatment in older adults who are not GH deficient. At the present time, there are insufficient data on sustained efficacy, safety, or cost effectiveness to support the use of GH as an anabolic agent in adults over 60 years of age.