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Bone density in children treated with gonadotropin-releasing hormone analogs for central precocious puberty

Franco Antoniazzi1, Elena Monti2, Rossella Gaudino3

  • 1a Associate Professor of Pediatrics, Department of Mother and Child, Biology and Genetics, Pediatric Clinic, University of Verona, Policlinico Giambattista Rossi, Piazza Ludovico Antonio Scuro, 10, I-37134 Verona, Italy. franco.antoniazzi@univr.it.

Expert Review of Endocrinology & Metabolism
|February 16, 2019
PubMed

Insights

Gonadotropin-releasing hormone analogs (GnRHa) treatment for precocious puberty can lower estrogen levels, potentially impacting bone density. However, studies suggest it does not prevent achieving normal peak bone mass, and calcium may enhance bone health.

Area of Science:

  • Endocrinology
  • Pediatrics
  • Bone Biology

Background:

  • Estrogens, growth hormones, and IGFs are critical for skeletal development, bone mass, and density.
  • Treatment for precocious puberty using gonadotropin-releasing hormone analogs (GnRHa) induces hypoestrogenism by lowering sex-steroid levels.
  • This hormonal change theoretically poses a risk to bone mass during crucial pubertal development.

Purpose of the Study:

  • To evaluate the long-term effects of GnRHa treatment on bone mineral density in children with central precocious puberty.
  • To determine if GnRHa treatment impacts the attainment of peak bone mass at adult height.
  • To assess the efficacy of calcium supplementation in mitigating potential negative effects on bone health.

Main Methods:

  • Review of studies examining bone mineral density in patients undergoing GnRHa therapy for central precocious puberty.
  • Analysis of data on peak bone mass achievement in treated individuals compared to controls.
  • Evaluation of studies incorporating calcium supplementation during GnRHa treatment.

Main Results:

  • A reduction in bone mineral density has been observed during GnRHa treatment.
  • Despite temporary reductions, GnRHa treatment does not appear to hinder the achievement of normal peak bone mass by adult height.
  • Calcium supplementation has demonstrated effectiveness in improving bone densitometry levels.

Conclusions:

  • GnRHa treatment for central precocious puberty may cause transient decreases in bone density but does not compromise the attainment of optimal peak bone mass.
  • Calcium supplementation is a beneficial intervention, improving bone densitometry and potentially enhancing peak bone mass acquisition in patients on GnRHa therapy.

Keywords:
bone mineral densitycentral precocious pubertydual-energy x-ray absorptiometrygonadotropin-releasing hormone analogpeak bone mass

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