Effect on bone mineralization of continued growth hormone therapy at the transition between childhood and adulthood

Childhood-onset growth-hormone deficiency (GHD) requires growth-hormone therapy (GHT) to optimize final height. GHT may also have benefits after final height is achieved, notably on bone. The objective of this retrospective single-center observational cohort study of patients who had persistent GHD after achieving their final height was to assess bone parameters at the transition to adult care and then more than 6 months later (6.08 (3.33-10.25) years). Bone mineral density (BMD) and Z-score at the lumbar spine and hip were determined. Of 162 patients transitioned to adult care in 1994-2021, 105 received GHT for longer than 6 months (GHT group) and 57 received either no GHT or GHT for less than 6 months (no-GHT group); however, BMD and Z-score data from both evaluations were available for only a minority of patients. Lumbar-spine BMD was significantly higher at the second evaluation in the GHT group than in the no-GHT group (P = 0.034). The lumbar-spine Z-scores at the first and second evaluations were -1.61 and -1.32 in the no-GHT group vs -1.09 and -0.61 in the GHT group (P = 0.047 for the difference in median change over time between groups). Changes in BMD at the lumbar spine and in BMD and Z-score at the femoral neck were not significantly different between the two groups. These results suggest beneficial effects of continued GHT in patients with persistent GHD after final height attainment, adding evidence to continue GH therapy during and after the transition period.

Children with insufficient growth-hormone levels are given growth-hormone injections to allow them to gain height. Once the final height is achieved, the treatment is often stopped. However, further treatment during the transition to adulthood may have benefits, notably on bone.