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Increased fracture frequency in adult patients with hypopituitarism and GH deficiency
T Rosén1, L Wilhelmsen, K Landin-Wilhelmsen
1Research Centre for Endocrinology and Metabolism, Sahlgrenska University Hospital, Göteborg, Sweden.
Insights
Adults with growth hormone deficiency (GHD) experience a threefold higher fracture rate. This study highlights increased fracture risk in hypopituitary patients, suggesting potential benefits from growth hormone (GH) therapy.
Area of Science:
- Endocrinology
- Bone Metabolism
- Clinical Research
Background:
- Hypopituitarism, a condition of deficient pituitary hormone production, affects adults and requires lifelong management.
- Growth hormone deficiency (GHD) is a common component of hypopituitarism, impacting bone health and overall well-being.
- The fracture risk in adult GHD patients receiving standard hormone replacement therapy (excluding GH) is not well-established.
Purpose of the Study:
- To investigate the fracture frequency in adult patients with hypopituitarism and GHD.
- To compare fracture rates in GHD patients with a healthy reference population.
- To assess potential differences in fracture risk between men and women with GHD.
Main Methods:
- A cohort of 107 hypopituitary patients with GHD (69 men, 38 women) was studied.
- Fracture history was assessed via questionnaires.
- A subsample from the Göteborg WHO MONICA Project (n=323) served as the control group.
Main Results:
- Total fracture frequency was threefold higher in GHD patients (24.1%) compared to controls (8.7%) (OR 3.49, P < 0.001).
- Men with GHD showed a significantly increased fracture frequency (25.0%) versus male controls (7.8%) (OR 3.97, P < 0.001).
- Women with GHD also had a higher fracture frequency (21.7%) compared to female controls (9.5%), though not statistically significant (P = 0.08).
Conclusions:
- Adult hypopituitary patients with GHD have a significantly elevated risk of fractures.
- The findings suggest that GHD may contribute to bone fragility independent of other pituitary hormone deficiencies.
- Further research is warranted to determine if recombinant human GH therapy can mitigate this increased fracture risk.
Abstract:
Fracture frequency was studied in 107 hypopituitary patients with GH deficiency (GHD) (69 men, mean age 53 years, range 18-74 and 38 women, mean age 54 years, range 31-73). Routine hormonal replacement therapy was given, except GH. Five male patients and 15 female patients with untreated hypogonadism were allocated to a separate group. The mean duration of hypopituitarism was 13.4 years. The prevalence of a history of fractures was assessed using questionnaires. A subsample of the Göteborg WHO MONICA Project was used as a reference population (n = 323). The total fracture frequency was threefold higher (P < 0.001) in patients (24.1%) compared with controls (8.7%) (odds ratio 3.49) (1.85-6.56; 95% confidence intervals). In men (n = 64) the fracture frequency was 25.0%, compared with 7.8% among the controls (P < 0.001). In women (n = 23) the fracture frequency was 21.7%, compared with 9.5% among the controls (P = 0.08). The odds ratios for fracture frequency were 3.97 (1.81-8.40; 95% confidence intervals) and 2.64 (0.89-7.81; 95% confidence intervals) in men and women respectively. In conclusion, adult hypopituitary patients with GHD had a threefold increased fracture frequency compared with controls. Further studies are needed to ascertain whether long-term recombinant human GH treatment can reduce the fracture rate in hypopituitary patients with GHD.