Kapteijns-van Kordelaar Simone, Noordam Kees, Otten Barto, van den Bergh Joop
Department of Paediatric Endocrinology, A University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
Eur J Pediatr. 2003 Nov;162(11):776-80. doi: 10.1007/s00431-003-1300-1. Epub 2003 Sep 17.
To evaluate the effect of gonadotrophin-releasing hormone (GnRH) agonist treatment on bone quality at final height, we studied girls with central precocious puberty (CPP) and with idiopathic short stature (ISS). A total of 25 Caucasian girls were included: group A (n=14) with idiopathic CPP (mean age at start 7.4 years) and group B (n=11) with ISS (mean age at start 11.7 years). Treatment duration was 3.8 and 1.7 years respectively. The quantitative ultrasound parameters (QUS) broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured at the calcaneus (UBIS 3000 device). Lumbar spine bone mineral density (BMD; L2-L4) was measured by dual energy X-ray absorptiometry (DXA) (Hologic QDR1000). Measurements were performed at final height and expressed as Z-scores corrected for bone age. Mean Z-scores of QUS parameters, areal BMD and volumetric BMD (BMDvol) were above -1 in both groups (group A: BUA Z-score -0.21, SOS Z-score -0.29, BMD Z-score 0.02, BMDvol Z-score 0.05, group B: BUA Z-score -0.93, SOS Z-score -0.40, BMD Z-score -0.86, BMDvol Z-score -0.68), although mean Z-scores of BUA and areal BMD in group B were significantly different from zero (P=0.03 and P=0.02 respectively). Mean Z-score BMDvol was not significantly different from zero (P=0.05), we found no significant difference between the groups for BMDvol (P=0.13).
Although quantitative ultrasound parameters parameters and bone mineral density were normal in girls with central precocious puberty at final height after gonadotrophin-releasing hormone agonist treatment, mean Z-score for broadband ultrasound attenuation and areal bone mineral density were significantly different from zero and mean Z-score for volumetric bone mineral density was (just) not significantly different from zero in idiopathic short stature girls with normal puberty treated with gonadotrophin-releasing hormone agonists. Therefore we cannot say that this treatment is safe in these girls with regard to bone health.
为评估促性腺激素释放激素（GnRH）激动剂治疗对最终身高时骨质量的影响，我们研究了中枢性性早熟（CPP）女孩和特发性身材矮小（ISS）女孩。共纳入25名白种女孩：A组（n = 14）为特发性CPP（开始治疗时平均年龄7.4岁），B组（n = 11）为ISS（开始治疗时平均年龄11.7岁）。治疗持续时间分别为3.8年和1.7年。使用定量超声参数（QUS）在跟骨处测量宽带超声衰减（BUA）和声速（SOS）（UBIS 3000设备）。通过双能X线吸收法（DXA）（Hologic QDR1000）测量腰椎骨密度（BMD；L2 - L4）。在最终身高时进行测量，并表示为根据骨龄校正的Z值。两组QUS参数、面积骨密度和体积骨密度（BMDvol）的平均Z值均高于 - 1（A组：BUA Z值 - 0.21，SOS Z值 - 0.29，BMD Z值0.02，BMDvol Z值0.05；B组：BUA Z值 - 0.93，SOS Z值 - 0.40，BMD Z值 - 0.86，BMDvol Z值 - 0.68），尽管B组的BUA和面积骨密度平均Z值与零有显著差异（分别为P = 0.03和P = 0.02）。BMDvol的平均Z值与零无显著差异（P = 0.05），我们发现两组之间BMDvol无显著差异（P = 0.13）。
尽管促性腺激素释放激素激动剂治疗后，中枢性性早熟女孩在最终身高时的定量超声参数和骨密度正常，但在接受促性腺激素释放激素激动剂治疗的青春期正常的特发性身材矮小女孩中，宽带超声衰减的平均Z值和面积骨密度与零有显著差异，体积骨密度的平均Z值（刚好）与零无显著差异。因此，就骨骼健康而言，我们不能说这种治疗对这些女孩是安全的。
