Bone disease in patients receiving growth hormone

Area of Science:

• Pediatric Endocrinology
• Nephrology
• Skeletal Biology

Background:

• Recombinant growth hormone (GH) use is expanding to non-GH-deficient patients.
• Children with chronic renal failure (CRF) are increasingly treated with GH, necessitating evaluation of potential bone-related complications.

Purpose of the Study:

• To assess the safety and potential bone complications of GH therapy in children with CRF.
• To investigate the relationship between GH therapy and conditions such as slipped capital femoral epiphysis (SCFE) and avascular necrosis (AVN) in this patient population.

Main Methods:

• Review of recent studies on GH use in children with CRF.
• Analysis of reported cases of SCFE and AVN in GH-treated CRF patients.
• Monitoring of radiographic and biochemical markers including bone disease, calcium, phosphorus, and parathyroid hormone (PTH) levels.

Main Results:

• GH may stimulate chondrocyte proliferation and potentially weaken the epiphyseal plate.
• SCFE and AVN have been reported in GH-treated CRF patients, though causality is sometimes unclear due to pre-existing risk factors like renal osteodystrophy (ROD).
• Studies show no significant differences in ROD scores or key biochemical markers between treated and untreated CRF groups, except for a transient increase in alkaline phosphatase.

Conclusions:

• Children with CRF treated with GH require serial monitoring for AVN, SCFE, and ROD.
• Radiographic and biochemical surveillance, including calcium, phosphorus, alkaline phosphatase, and PTH levels, is crucial for early detection of complications.