Endocrine Abstracts

JOINT503

Background: Advanced bone age is a critical factor limiting height outcomes in growth disorders, including obesity-related short stature, congenital adrenal hyperplasia (CAH), precocious puberty, and small-for-gestational-age (SGA) conditions. Therapies such as growth hormone (GH), aromatase inhibitors (AIs), and gonadotropin-releasing hormone agonists (GnRHa) are used either independently or in combination to enhance height potential and manage bone age progression.

Objectives: This review aims to assess and compare the effectiveness of GH, AIs, and GnRHa therapies in treating advanced bone age across pediatric growth disorders. It evaluates their impact on height standard deviation score (HtSDS), predicted adult height (PAH), and bone age modulation.

Methods: Studies spanning 2000–2024 were analyzed. These studies encompassed diverse pediatric conditions with advanced bone age treated with GH, AIs, GnRHa, or combinations. Data on PAH improvements, bone age control, and side effects were extracted, focusing on therapeutic outcomes across conditions.

Results: A total of 25 studies were analyzed to evaluate therapeutic strategies for advanced bone age across four conditions: obesity-related short stature, CAH, precocious puberty, and small SGA. The studies highlighted the efficacy of GH therapy, GnRHa, and AIs, either alone or in combination. Six studies reported that GH combined with GnRHa or AIs improved predicted adult height and controlled bone age progression in obesity-related short stature, with early intervention yielding the best outcomes. For CAH, five studies demonstrated that combination therapies (e.g., GH + GnRHa + AI) significantly improved height SDS while controlling androgen-induced bone maturation, especially in prepubertal patients. Eight studies on precocious puberty confirmed the effectiveness of GnRHa in delaying bone age advancement, with combination therapy (GnRHa + GH or GnRHa + AI) yielding superior height outcomes. In four studies examining SGA, GH alone or in combination with AIs consistently promoted significant height gains and moderately delayed bone age, particularly with early intervention. Across all conditions, combination therapies outperformed monotherapy in managing bone age progression and optimizing growth, with minimal but manageable adverse effects.

Discussion: The findings underscore the importance of condition-specific approaches to optimize outcomes. Early diagnosis and intervention are critical, particularly in obesity-related short stature and SGA, where early skeletal maturation poses significant barriers to achieving optimal height.

Conclusion: Combination therapies tailored to the underlying pathology of advanced bone age provide the most effective strategies for improving height and managing bone age progression in growth disorders. Future research should focus on safety, and personalized treatment algorithms to maximize benefits across conditions.