Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA,
Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
Horm Res Paediatr. 2019;92(5):293-301. doi: 10.1159/000506229. Epub 2020 Mar 30.
Although growth hormone (GH) is essential for attainment of peak bone mass, bone health in prepubertal children with GH deficiency is not routinely evaluated. The objective of this study was to evaluate bone microarchitecture in GH-deficient (GHD) boys using high-resolution peripheral quantitative computed tomography (HR-pQCT).
Fifteen control and fifteen GHD, GH naïve pre-pubertal boys were recruited for a case-control study at a major academic center. Subjects with panhypopituitarism, chromosomal pathology, chronic steroids, or stimulant use were excluded. Volumetric bone mineral density (vBMD; total, cortical, and trabecular), bone geometry (total, cortical and trabecular cross-sectional area, cortical perimeter), bone microarchitecture, and estimated bone strength of the distal radius and tibia were assessed by HR-pQCT. Areal BMD and body composition were assessed by DXA. Insulin-like growth factor 1 (IGF-1), osteocalcin, C telopeptide, and P1NP levels were measured.
GHD subjects had a significantly smaller cortical perimeter of the distal radius compared to controls (p < 0.001), with the difference in cortical perimeter persisting after adjusting for height z score, age, lean mass, and 25-hydroxyvitamin D level (p < 0.05).No significant differences were found in vBMD. No significant differences were found in microarchitecture, estimated strength, areal BMD, body composition, or bone turnover markers. Analysis showed significant positive correlations between IGF-1 levels and cortical parameters.
DISCUSSION/CONCLUSIONS: Prepubertal GHD boys had deficits in bone geometry not evident with DXA. Larger prospective/longitudinal HR-pQCT studies are needed to determine the extent of these deficits, the need for routine bone evaluation, and the timing of GH replacement for prevention or restoration of these deficits.
尽管生长激素（GH）对于达到峰值骨量至关重要，但对于 GH 缺乏的青春期前儿童的骨骼健康通常未进行常规评估。本研究的目的是使用高分辨率外周定量 CT（HR-pQCT）评估 GH 缺乏（GHD）男孩的骨微结构。
在一家主要学术中心，我们招募了 15 名对照和 15 名 GHD、GH 初治青春期前男孩进行病例对照研究。排除了患有全垂体功能减退症、染色体病理学、长期使用类固醇或兴奋剂的患者。使用 HR-pQCT 评估了桡骨远端和胫骨的容积骨矿物质密度（vBMD；总、皮质和小梁）、骨几何形状（总、皮质和小梁横截面积、皮质周长）、骨微结构和估计的骨强度。通过 DXA 评估了面积骨密度和身体成分。测量了胰岛素样生长因子 1（IGF-1）、骨钙素、C 端肽和 P1NP 水平。
与对照组相比，GHD 受试者的桡骨远端皮质周长明显较小（p < 0.001），调整身高 z 评分、年龄、瘦体重和 25-羟维生素 D 水平后，皮质周长的差异仍然存在（p < 0.05）。vBMD 无显著差异。微结构、估计强度、面积骨密度、身体成分或骨转换标志物均无显著差异。分析显示 IGF-1 水平与皮质参数呈显著正相关。
讨论/结论：青春期前 GHD 男孩的骨几何形状存在缺陷，而 DXA 无法检测到这些缺陷。需要更大的前瞻性/纵向 HR-pQCT 研究来确定这些缺陷的程度、常规骨骼评估的必要性以及 GH 替代治疗的时机，以预防或恢复这些缺陷。
