Department of Dietetics and Nutrition, All India Institute of Medical Sciences, New Delhi, India.
Osteoporos Int. 2012 Aug;23(8):2211-7. doi: 10.1007/s00198-011-1825-5. Epub 2011 Nov 10.
Growth hormone deficiency (GHD) in children has been frequently perceived to be a cause of low bone mass accrual. The confounding effects of poor growth limit the interpretation of prior studies of bone health in GHD. We studied size-corrected bone mineral measures in 30 pre-pubertal GHD children and 75 healthy controls. Our study shows that size-corrected whole-body bone mineral content of GHD children were comparable with controls.
The purpose of this study is to evaluate the effects of GHD on size-corrected bone measures at the lumbar spine (LS) and the whole body (WB).
LS bone area (BA), LS bone mineral content (BMC), WB BA, WB BMC, and lean body mass (LBM) were measured in 30 pre-pubertal GHD children and 75 controls by dual-energy X-ray absorptiometry. Multiple linear regressions were used to calculate size-corrected (Sc) LS BA(Sc), LS BMC(Sc), WB BA(Sc), and WB BMC(Sc) from control subjects using height and age as independent variables. Furthermore, the relationship between muscle and bone was studied by first assessing LBM for height (LBM(Ht)) and then determining WB BMC for LBM (WB BMC(LBM)). All values were converted to Z-scores and compared with the control.
At diagnosis, WB BMC(Sc) Z-score of GHD children was not significantly different from controls. However, mean Z-scores of LS BA(Sc) (-0.89 ± 0.84, p < 0.0001), LS BMC(Sc) (-0.70 ± 1.1, p < 0.001), WB BA(Sc) (-0.65 ± 1.0, p < 0.006), and LBM(Ht) (-0.66 ± 1.7, p < 0.01) were significantly reduced, and WB BMC(Lbm) (0.78 ± 1.5, p < 0.003) was significantly higher in GHD children than controls.
Size-corrected WB BMC of GHD children were comparable with controls, and bones were normally adapted for muscle mass. Determinants of bone strength which may primarily be affected by GHD are muscle mass, bone size, and geometry rather than bone mass.
本研究旨在评估生长激素缺乏（GHD）对腰椎（LS）和全身（WB）部位校正后骨量的影响。
采用双能 X 线吸收法测量 30 例青春期前 GHD 患儿和 75 例健康对照者的 LS 骨面积（BA）、LS 骨矿物质含量（BMC）、WB BA、WB BMC 和瘦体重（LBM）。采用多元线性回归，以身高和年龄为自变量，计算对照组的校正后 LS BA（Sc）、LS BMC（Sc）、WB BA（Sc）和 WB BMC（Sc）。此外，通过先评估 LBM 与身高的关系（LBM（Ht）），然后确定 LBM 与 WB BMC 的关系（WB BMC（LBM）），研究肌肉与骨骼的关系。所有值均转换为 Z 分数，并与对照组进行比较。
在诊断时，GHD 患儿的 WB BMC（Sc）Z 评分与对照组无显著差异。然而，LS BA（Sc）（-0.89±0.84，p<0.0001）、LS BMC（Sc）（-0.70±1.1，p<0.001）、WB BA（Sc）（-0.65±1.0，p<0.006）和 LBM（Ht）（-0.66±1.7，p<0.01）的 Z 评分显著降低，而 GHD 患儿的 WB BMC（Lbm）（0.78±1.5，p<0.003）显著升高。
GHD 患儿的校正后 WB BMC 与对照组相当，骨骼对肌肉质量有正常的适应性。可能主要受 GHD 影响的骨强度决定因素是肌肉质量、骨大小和几何形状，而不是骨量。
