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Growth hormone therapy improves bone mineral density in children with cerebral palsy: a preliminary pilot study
Omar Ali1, Melanie Shim, Eileen Fowler
1David Geffen School of Medicine at University of California, Los Angeles, California 90095, USA.
Insights
Growth hormone (GH) therapy in children with cerebral palsy significantly improved spinal bone mineral density (BMD) and linear growth over 18 months. This pilot study indicates GH therapy is a promising treatment for bone health and stature in this population.
Area of Science:
- Pediatric Endocrinology
- Orthopedics
- Biochemistry
Background:
- Cerebral palsy (CP) is linked to osteopenia, increased fracture risk, short stature, and reduced muscle mass.
- Growth hormone (GH) therapy is known to enhance bone mineral density (BMD), linear growth, and body composition.
Purpose of the Study:
- To assess the 18-month impact of GH therapy on spinal BMD, linear growth, biochemical markers, and functional measures in children with cerebral palsy.
- To evaluate the efficacy of GH in addressing common skeletal and growth-related issues in CP.
Main Methods:
- A randomized controlled trial involving 12 male pediatric patients with cerebral palsy (ages 4.5-15.4 years).
- Comparison of 18 months of GH therapy (50 mcg daily) versus no treatment.
- Assessment of spinal BMD via dual-energy x-ray absorptiometry, height, growth factors, and bone markers.
Main Results:
- GH therapy led to a statistically significant increase in height z-scores (0.67 vs. -0.01, P = 0.01) and spinal BMD z-scores (1.169 vs. 0.24, P = 0.03).
- Biochemical markers including osteocalcin, IGF-I, and IGF-binding protein 3 levels showed increases with GH treatment.
- No significant changes were observed in quality of life scores using the Pediatric Orthopedic Disability Inventory.
Conclusions:
- This pilot study suggests that 18 months of GH therapy is associated with statistically significant improvements in spinal BMD and linear growth in children with cerebral palsy.
- GH therapy may be a beneficial intervention for improving bone health and linear growth in pediatric patients with CP.
Context:
Cerebral palsy is associated with osteopenia, increased fracture risk, short stature, and decreased muscle mass, whereas GH therapy is associated with increased bone mineral density (BMD) and linear growth and improvement in body composition.
Objective:
We conducted a pilot study to evaluate the effect of 18 months of GH therapy on spinal BMD, linear growth, biochemical markers, and functional measures in children with cerebral palsy.
Design And Setting:
The study was a randomized control trial, conducted from 2002-2005 at the University of California, Los Angeles, Orthopedic Hospital's Center for Cerebral Palsy.
Patients:
Patients included 12 males with cerebral palsy, ages 4.5-15.4 yr.
Intervention:
We compared 18 months of GH (50 microg daily) vs. no treatment.
Primary Outcome Measures:
Spinal BMD (dual-energy x-ray absorptiometry scan), height, growth factors, and bone markers were assessed.
Results:
Ten subjects (five in each group) completed the study. Pre- and post-average height z-scores were -1.47 +/- 0.23 and 0.8 +/- 0.2 (GH-treated group) vs. -1.35 +/- 1.26 and -1.36 +/- 1.27 (control group) (Delta SD score, 0.67 vs. -0.01; P = 0.01). Average change in spinal BMD z-score (Delta SD score corrected for height) was 1.169 +/- 0.614 vs. 0.24 +/- 0.25 in the treated and control groups, respectively (P = 0.03). Osteocalcin, IGF-I, and IGF-binding protein 3 levels increased during GH therapy. There was no change in quality of life scores as measured by the Pediatric Orthopedic Disability Inventory.
Conclusions:
This small pilot study suggests that 18 months of GH therapy is associated with statistically significant improvement in spinal BMD and linear growth.
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