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Deficits in Bone Geometry in Growth Hormone-Deficient Prepubertal Boys Revealed by High-Resolution Peripheral
Tamar G Baer1, Sanchita Agarwal2, Shaoxuan Chen3
1Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA, tamgbaer@gmail.com.
Insights
Prepubertal boys with growth hormone deficiency (GHD) show smaller bone dimensions, specifically cortical perimeter, not detected by standard DXA scans. Further research is needed to assess long-term bone health and optimal treatment timing.
Area of Science:
- Pediatric Endocrinology
- Bone Biology
- Medical Imaging
Background:
- Growth hormone (GH) is crucial for achieving peak bone mass.
- Bone health in prepubertal children with GH deficiency (GHD) is often unevaluated.
- High-resolution peripheral quantitative computed tomography (HR-pQCT) can assess bone microarchitecture.
Purpose of the Study:
- To evaluate bone microarchitecture in prepubertal GHD boys using HR-pQCT.
- To compare bone geometry and microarchitecture between GHD and control boys.
- To identify potential bone deficits not detectable by dual-energy X-ray absorptiometry (DXA).
Main Methods:
- A case-control study involving 15 GHD and 15 control prepubertal boys.
- HR-pQCT assessed volumetric bone mineral density (vBMD), bone geometry, microarchitecture, and estimated bone strength.
- DXA measured areal BMD and body composition.
- Blood samples analyzed for IGF-1, osteocalcin, C-telopeptide, and P1NP.
Main Results:
- GHD boys exhibited a significantly smaller cortical perimeter of the distal radius compared to controls (p < 0.001).
- This difference persisted after adjusting for height z-score, age, lean mass, and vitamin D levels (p < 0.05).
- No significant differences were found in vBMD, microarchitecture, estimated strength, areal BMD, body composition, or bone turnover markers.
Conclusions:
- Prepubertal GHD boys demonstrate bone geometry deficits not apparent with DXA.
- Larger longitudinal studies are required to determine the extent of these deficits.
- Further research should guide routine bone evaluation and the timing of GH replacement therapy.
Introduction:
Although growth hormone (GH) is essential for attainment of peak bone mass, bone health in prepubertal children with GH deficiency is not routinely evaluated. The objective of this study was to evaluate bone microarchitecture in GH-deficient (GHD) boys using high-resolution peripheral quantitative computed tomography (HR-pQCT).
Methods:
Fifteen control and fifteen GHD, GH naïve pre-pubertal boys were recruited for a case-control study at a major academic center. Subjects with panhypopituitarism, chromosomal pathology, chronic steroids, or stimulant use were excluded. Volumetric bone mineral density (vBMD; total, cortical, and trabecular), bone geometry (total, cortical and trabecular cross-sectional area, cortical perimeter), bone microarchitecture, and estimated bone strength of the distal radius and tibia were assessed by HR-pQCT. Areal BMD and body composition were assessed by DXA. Insulin-like growth factor 1 (IGF-1), osteocalcin, C telopeptide, and P1NP levels were measured.
Results:
GHD subjects had a significantly smaller cortical perimeter of the distal radius compared to controls (p < 0.001), with the difference in cortical perimeter persisting after adjusting for height z score, age, lean mass, and 25-hydroxyvitamin D level (p < 0.05).No significant differences were found in vBMD. No significant differences were found in microarchitecture, estimated strength, areal BMD, body composition, or bone turnover markers. Analysis showed significant positive correlations between IGF-1 levels and cortical parameters.
Discussion/Conclusions:
Prepubertal GHD boys had deficits in bone geometry not evident with DXA. Larger prospective/longitudinal HR-pQCT studies are needed to determine the extent of these deficits, the need for routine bone evaluation, and the timing of GH replacement for prevention or restoration of these deficits.
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