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. 2013 Aug;79(2):178-84.
doi: 10.1111/cen.12132. Epub 2013 Apr 5.

Predictors of the effects of 4 years of growth hormone replacement on bone mineral density in patients with adult-onset growth hormone deficiency - a KIMS database analysis

Nicholas A Tritos  1 , Amir H Hamrahian, Donna King, Susan L Greenspan, David M Cook, Peter J Jönsson, Maria Koltowska-Häggstrom, Beverly M K Biller
Affiliations

Predictors of the effects of 4 years of growth hormone replacement on bone mineral density in patients with adult-onset growth hormone deficiency - a KIMS database analysis

Nicholas A Tritos et al. Clin Endocrinol (Oxf). 2013 Aug.

Abstract

Objective: Growth hormone (GH) replacement may increase bone mineral density (BMD) in GH-deficient (GHD) adults. The goal of this study was to identify predictors of BMD response to GH replacement in GH naïve adults.

Design and measurements: This was a retrospective analysis of data extracted from KIMS (Pfizer International Metabolic Database), an international pharmacoepidemiological survey of adult GHD patients from 31 countries.

Patients: A total of 231 GH naive adults were identified (115 women and 116 men) who had BMD measured on the same densitometer in the lumbar spine (LS) and/or femoral neck (FN) both at baseline and after 4 years of GH replacement.

Results: After 4 years, there was a median (10th, 90th percentile) 4·6% (-5·2%, 12·2%) increase in LS BMD over baseline (P = 0·0001). There was a positive correlation between per cent change in LS BMD and age at the onset of pituitary disease (r = 0·25, P = 0·001). There was no change in FN BMD over baseline [0·0% (-7·3%, 8·5%)]. On multivariate analysis, older age at the onset of pituitary disease predicted a greater increase in LS BMD on GH replacement (r = 0·55, P < 0·0001).

Conclusions: In a population of GH naïve adults, GH replacement led to a significant increase in LS BMD over baseline, but no change in FN BMD. The potential for greater BMD improvement on GH replacement therapy in adults with disease of later onset should be considered when making treatment decisions in this patient population.

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Conflict of interest statement

Competing interests

N.A.T. has been a recipient of research funding from Pfizer and Ipsen, and received consulting fees from Pfizer; spouse is an employee of Pfizer. A.H.H. has been a recipient of lecture fees from Novartis, Ipsen and Pfizer, and has served as consultant to Ipsen and Pfizer. S.L.G. has been a recipient of research funding from Eli Lilly, Warner Chilcott, Tarsa, and has consulted and served on an advisory board for Amgen and Merck. D.K., P.J.J. and M.K-H. are full-time employees of Pfizer. B.M.K.B. has been a recipient of research funding from Pfizer, Novo Nordisk and Serono, has served on an advisory board with consulting fees from Pfizer and Novo Nordisk.

Figures

Fig. 1
Fig. 1
Causes of growth hormone deficiency (GHD) in the study population (per cent total), adapted a previously defined Classification List.
Fig. 2
Fig. 2
Association between per cent change in lumber spine (LS) bone mineral density (BMD) over baseline and age at the onset of pituitary disease.
Fig. 3
Fig. 3
See this image and copyright information in PMC

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