ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 16 P91

Determinants of spinal deformities in adult patients with untreated growth hormone deficiency (GHD)

Gherardo Mazziotti1, Antonio Bianchi2, Stefania Bonadonna1, Vincenzo Cimino2, Alessandra Fusco2, Ilaria Patelli1, Laura De Marinis2 & Andrea Giustina1

1University of Brescia, Brescia, Italy; 2Catholic University of Rome, Rome, Italy.

Adult GHD patients may have reduced BMD with high risk of vertebral and non-vertebral fractures which is thought to be reverted by long-term rhGH replacement therapy. In this study we aimed at identifying the determinant factors of vertebral fractures, as assessed by a radiological morphometric approach, in a cohort of adult patients with untreated GHD. Forty-two patients (27 males, 15 females; median age: 48 years, range: 30–67) with untreated severe (as defined by a peak GH response to a stimulation test of <3 μg/l) GHD were evaluated for vertebral deformities (T4-L5 quantitative morphometric analysis according to Genant score) and bone mineral density (dual-energy X-ray absorptiometry). Radiological vertebral fractures were found in 33 patients (78.6%). Twenty-two patients had two or more fractures, whereas in 11 patients the fractures were single. Moreover, the fractures were mild in 54.8%, moderate in 19.0% and severe in 7.1% of patients. Fractured patients had a duration of GHD significantly longer as compared with the patients who were found without vertebral fractures (10.4±1.9 vs 3.4±0.9 years; P=0.002). The duration of GHD was also correlated with the number of fractures. Fractured and non-fractured patients showed not significant differences in age, sex, bone mineral density, prevalence of untreated hypogonadism. Moreover, fractured and non-fractured patients showed comparable serum IGF-I values (79.3±6.9 ng/ml vs 89.7±12.3 ng/ml). However, serum IGF-I values were correlated with the number of vertebral fractures, independently of the duration of GHD. In fact, in the patients with lower serum IGF-I values (1st tertile) the prevalence of multiple spinal fractures was significantly greater as compared to patients with higher IGF-I values (3rd tertile; 76.9% vs 33.3%; P=0.01), although the two groups of patients did not show significant differences in the overall prevalence of vertebral deformities (86.7% vs 73.3%). Furthermore, the patients with severe spinal fractures showed significantly lower IGF-I values as compared to patients with mild spinal deformities (39.7±15 ng/ml vs 90±7.6 ng/ml; P=0.009). In conclusion, in adult patients with untreated GHD the duration of disease seems to be the main predictor of vertebral fracture risk. However, patients with lower serum IGF-I levels are those at risk of a more severe bone impairment.

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