Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Eur J Endocrinol. 2022 Apr 21;186(6):619-629. doi: 10.1530/EJE-21-1061.
Overweight/obesity is associated with relative growth hormone (GH) deficiency and increased fracture risk. We hypothesized that GH administration would improve bone endpoints in individuals with overweight/obesity.
An 18-month, randomized, double-blind, placebo-controlled study of GH, followed by 6-month observation.
In this study, 77 adults (53% men), aged 18-65 years, BMI ≥ 25 kg/m2, and BMD T- or Z-score ≤ -1.0 were randomized to daily subcutaneous GH or placebo, targeting IGF1 in the upper quartile of the age-appropriate normal range. Forty-nine completed 18 months. DXA, volumetric quantitative CT, and high-resolution peripheral quantitative CT were performed.
Pre-treatment mean age (48 ± 12 years), BMI (33.1 ± 5.7 kg/m2), and BMD were similar between groups. P1NP, osteocalcin, and CTX increased (P < 0.005) and visceral adipose tissue decreased (P = 0.04) at 18 months in the GH vs placebo group. Hip and radius aBMD, spine and tibial vBMD, tibial cortical thickness, and radial and tibial failure load decreased in the GH vs placebo group (P < 0.05). Between 18 and 24 months (post-treatment observation period), radius aBMD and tibia cortical thickness increased in the GH vs placebo group. At 24 months, there were no differences between the GH and placebo groups in bone density, structure, or strength compared to baseline.
GH administration for 18 months increased bone turnover in adults with overweight/obesity. It also decreased some measures of BMD, bone microarchitecture, and bone strength, which all returned to pre-treatment levels 6 months post-therapy. Whether GH administration increases BMD with longer treatment duration, or after mineralization of an expanded remodeling space post-treatment, requires further investigation.
超重/肥胖与相对生长激素（GH）缺乏和骨折风险增加有关。我们假设 GH 治疗会改善超重/肥胖个体的骨终点。
一项为期 18 个月、随机、双盲、安慰剂对照的 GH 治疗研究，随后进行 6 个月的观察。
本研究纳入了 77 名年龄在 18-65 岁、BMI≥25kg/m2 且 BMD T 或 Z 评分≤-1.0 的成年人（53%为男性），他们被随机分配接受每日皮下 GH 或安慰剂治疗，以将 IGF1 靶向至年龄相关正常范围的上四分位数。49 名患者完成了 18 个月的治疗。使用 DXA、容积定量 CT 和高分辨率外周定量 CT 进行检测。
治疗前，两组的平均年龄（48±12 岁）、BMI（33.1±5.7kg/m2）和 BMD 相似。与安慰剂组相比，GH 组在治疗 18 个月时 P1NP、骨钙素和 CTX 增加（P<0.005），内脏脂肪组织减少（P=0.04）。与安慰剂组相比，GH 组的髋部和桡骨 aBMD、脊柱和胫骨 vBMD、胫骨皮质厚度以及桡骨和胫骨失效负荷降低（P<0.05）。在 18 至 24 个月（治疗后观察期），GH 组的桡骨 aBMD 和胫骨皮质厚度增加。与基线相比，24 个月时 GH 组与安慰剂组在骨密度、结构或强度方面无差异。
GH 治疗 18 个月可增加超重/肥胖成年人的骨转换。它还降低了一些 BMD、骨微结构和骨强度的测量值，所有这些值在治疗后 6 个月均恢复至治疗前水平。GH 治疗是否会增加骨密度，或者在治疗后重塑空间矿化增加时增加骨密度，需要进一步研究。
