There is some evidence that bone mass is reduced in the majority of adult patients with growth hormone deficiency (GHD), suggesting that such patients have an increased risk of fractures and clinically significant osteoporosis. To date, there have been only two reports of fracture rates in patients with hypopituitarism. Both these retrospective studies show an increased fracture prevalence in this patient group compared with the general population, but patient numbers were low for assessing fracture rates. However, an analysis of data from a large-scale pharmacoepidemiological survey of adults with GHD, KIMS (Pharmacia International Metabolic Database), confirms the findings of these earlier studies. The prevalence of all fractures among patients in KIMSwas 2.7 times that in the control population, and the risk of fracture was independent of whether patients had isolated GHD or multiple pituitary hormone deficiencies. The results suggest that GHD is a risk factor for fractures, if a direct endocrine cause is assumed. Notably, there are some data on subgroup analyses from KIMS suggesting that growth hormone replacement therapy may help to reduce fracture risk, although further evidence is needed to confirm this effect.

Melton LJ 3rd, Atkinson EJ, O’Fallon WM, Wahner HW, Riggs BL: Long-term fracture prediction by bone mineral assessed at different skeletal sites. J Bone Miner Res 1993;8:1227–1233.
Wüster C, Slenczka E, Ziegler R: Increased prevalence of osteoporosis and arteriosclerosis in patients with conventionally substituted pituitary insufficiency: Is there a need for additional growth hormone substitution? Klin Wochenschr 1991;69:769–773.
Wüster C: Growth hormone and bone. Acta Endocrinol (Copenh) 1993;128(suppl 2):14–18.
Kaufman JM, Taelman P, Vermeulen A, Vandeweghe M: Bone mineral status in growth hormone-deficient males with isolated and multiple pituitary deficiencies of childhood onset. J Clin Endocrinol Metab 1992;74:118–123.
Johansson AG, Burman P, Westermark K, Ljunghall S: The bone mineral density in acquired growth hormone deficiency correlates with circulating insulin-like growth factor I. J Intern Med 1992;232:447–452.
Hyer SL, Rodin DA, Tobias JH, Leiper A, Nussey SS: Growth hormone deficiency during puberty reduces adult bone mineral density. Arch Dis Child 1992;67:1472–1474.
Rosén T, Hansson T, Granhed H, Szucs J, Bengtsson B-Å: Reduced bone mineral content in adult patients with growth hormone deficiency. Acta Endocrinol (Copenh) 1993;129:201–206.
Bing-You RG, Denis MC, Rosen CJ: Low bone mineral density in adults with previous hypothalamic–pituitary tumors: correlations with serum GH responses to GHRH, IGF-I and IGFBP-3. Calcif Tissue Int 1993;52:183–187.
de Boer H, Blok GJ, van Lingen A, Teule GJJ, Lips P, van der Veen EA: Consequences of childhood-onset growth hormone deficiency for adult bone mass. J Bone Miner Res 1994;9:1319–1326.
Bravenboer N, Holzmann P, de Boer H, Roos JC, van der Veen EA, Lips P: The effect of growth hormone (GH) on histomorphometric indices of bone structure and bone turnover in GH-deficient men. J Clin Endocrinol Metab 1997;82:1818–1822.
Bravenboer N, Holzmann P, de Boer H, Blok GJ, Lips P: Histomorphometric analysis of bone mass and bone metabolism in growth hormone deficient adult men. Bone 1998;18:551–557.
Toogood AA, Adams JE, O’Neill PA, Shalet SM: Elderly patients with adult-onset growth hormone deficiency are not osteopenic. J Clin Endocrinol Metab 1997;82:1462–1466.
Kann P, Piepkorn B, Schehler B, Andreas J, Lotz J, Prellwitz W, Beyer J: Effect of long-term treatment with GH on bone metabolism, bone mineral density and bone elasticity in GH-deficient adults. Clin Endocrinol (Oxf) 1998;48:561–568.
Rosén T, Wilhelmsen L, Landin-Wilhelmsen K, Lappas G, Bengtsson B-Å: Increased fracture frequency in adult patients with hypopituitarism and GH deficiency. Eur J Endocrinol 1997;137:240–245.
Scheidt-Nave C, Ziegler R, Raspe H: Epidemiologie der Osteoporose. Med Klin 1998;93(suppl 2):7–11.
Wüster C, Abs R, Bengtsson B-Å, Bennmarker H, Feldt-Rasmussen U, Hernberg-Ståhl E, Monson JP, Westberg B, Wilton P: The influence of growth hormone (GH) deficiency, GH replacement therapy and other aspects of hypopituitarism on fracture rate and bone mineral density. J Bone Miner Res 2001;16:in press.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.