The Influence of Growth Hormone Deficiency, Growth Hormone Replacement Therapy, and Other Aspects of Hypopituitarism on Fracture Rate and Bone Mineral Density
Abstract
To assess the influence of factors affecting fracture risk and bone density in adult hypopituitary patients with growth hormone deficiency (GHD), data from a large-scale pharmacoepidemiological survey (the Pharmacia & Upjohn International Metabolic Database [KIMS]) were analyzed and compared with data from a control population (the European Vertebral Osteoporosis Study [EVOS]). The KIMS group consisted of 2084 patients (1112 men and 972 women) with various types of pituitary disease and EVOS consisted of 1176 individuals (581 men and 595 women). Fracture and bone mineral density (BMD) data were available from 2024 patients from the KIMS group and 392 patients from EVOS. The prevalence of fractures in patients with hypopituitarism was 2.66 times that in the non-GH-deficient EVOS population. Adult-onset hypopituitarism with GHD was associated with a higher fracture risk than childhood-onset disease, and patients with isolated GHD had a similar prevalence of fractures to those with multiple pituitary hormone deficiencies. Hormonal replacement therapy with L-thyroxine, glucocorticoids, and sex steroids did not affect the risk of fracture in KIMS patients. In addition, fracture rates in KIMS were independent of body mass index (BMI) and the country of origin. However, smoking was associated with a higher fracture rate in this group. In summary, this is the first large-scale analysis to support the hypothesis of an increased fracture risk in adult patients with hypopituitarism and GHD. This increased risk appears to be attributable to GHD alone, rather than to other pituitary hormone deficiencies or to their replacement therapy.
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Fracture rate is rather attributable to GHD alone than other pituitary hormone deficiencies or their replacement therapy.
“Studies suggest that fracture rate is rather attributable to GHD alone than other pituitary hormone deficiencies or their replacement therapy [51].”
From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [51]
GHD itself is crucial for the development of osteopenia in hypopituitary patients.
“Studies have shown that GHD itself is crucial for the development of osteopenia in hypopituitary patients [44, 49, 51].”
From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [51]
GHD and hypopituitarism are associated with increased fracture risk.
“It has been reported that GHD and hypopituitarism are associated with increased fracture risk [17, 44, 51, 55].”
From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [51]
There is a direct relation between GHD and decreased bone mass in hypopituitarism.
“A direct relation between GHD and decreased bone mass in hypopituitarism is supported by the fact that GH replacement therapy improves BMD values [51, 52].”
From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [51]
GH replacement therapy improves BMD values.
“GH replacement therapy improves BMD values [51, 52].”
From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [51]
BMD in patients with hypopituitarism and untreated GHD might be affected by age at onset, gender, body mass index, gonadal status, and severity of GHD.
“According to the literature BMD might be affected by many factors such as age at onset, gender, body mass index, gonadal status, and the severity of growth hormone deficiency [47, 49, 51].”
From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [51]
GH replacement therapy may reduce the risk of fracture in patients with hypopituitarism and GHD.
“Some studies suggest that GH replacement therapy may reduce the risk of fracture in patients with hypopituitarism and GHD [51, 59].”
From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [51]
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Fracture Incidence in GH-Deficient Patients on Complete Hormone Replacement Including GH
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Growth hormone replacement therapy in childhood-onset craniopharyngioma
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- Authors
- Wüster, C., Abs, R., Bengtsson, B.-Å., Bennmarker, H., Feldt-Rasmussen, U., Hernberg-Ståhl, E., Monson, J. P., Westberg, B., & Wilton, P.
- Affiliations
- Heidelberg University (DE)
- Antwerp University Hospital (BE)
- Sahlgrenska University Hospital (SE)
- KIMS Outcomes Research Department, Metabolic Diseases, Pharmacia & Upjohn, Stockholm, Sweden
- Clinic of Endocrinology, National University Hospital, Copenhagen, Denmark
- St Bartholomew's Hospital (GB)
- Venue
- Journal of Bone and Mineral Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2001-02-01
- Volume
- 16
- Issue
- 2
- Pages
- 398-405
- ISSN
- 0884-0431 (ISSN-L)
- 1523-4681
- OpenAlex
- W2036449739
- Cited by
- 267
- References
- 1
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 8 · 2023: 4 · 2022: 4 · 2021: 4 · 2020: 6 · 2019: 3 · 2018: 17 · 2017: 7 · 2016: 11 · 2015: 12 · 2014: 13 · 2013: 9 · 2012: 11
- FWCI
- 12.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Journal of Bone and Mineral Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Keywords
- growth hormone deficiency, hypopituitarism, fracture risk, bone mineral density, growth hormone replacement therapy, multiple pituitary hormone deficiency, smoking, levothyroxine, glucocorticoids, sex steroids, body mass index, osteoporosis
- MeSH terms
- Humans, Hypopituitarism, Growth Hormone, Bone Density, Prevalence, Age of Onset, Fractures, Bone
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