Growth hormone treatment in children with rheumatic disease, corticoid induced growth retardation and osteopenia

Fleur K Grote ^1*, Lisette W A Van Suijlekom-Smit ², Dick Mul ², Wim C J Hop ³, Rebecca Ten Cate ², Wilma Oostdijk ¹, Wilma van Luijk ⁴, C J A Jansen-van Wijngaarden ² and Sabine M P F De Muinck Keizer-Schrama ²

¹ Leiden University Medical Center, Netherlands
² Sophia Children's Hospital, Netherlands
³ University Medical Centre Groningen, Netherlands
⁴ University Hospital Groningen, Netherlands

^* To whom correspondence should be addressed. E-mail: f.k.grote{at}lumc.nl.

Accepted 28 September 2005

Abstract

Aims:In children with severe rheumatic disease (RD) treatment with corticosteroids (CS) is frequently needed and growth retardation and osteopenia may develop. A beneficial effect of human growth hormone (hGH) has been reported but mostly in trials without a control group. The aim of this project is to study the effect of hGH on growth, bone mineral density (BMD) and body composition,taking the disease activity and CS-use into account.

Methods:A randomised controlled trial on 17 prepubertal RD-patients with growth retardation and/or decreased BMD. The hGH-group (10 children) received treatment with hGH 4 IU/m2/day (~ 0.045 mg/kg/day) during two years. The controls (7 children) received no GH treatment.

Results:During the two-year study period the disease activity, use of CS and methotrexate (MTX) did not differ between the groups. There was a significant mean increase in height standard deviation score (HSDS) in the hGH-group (0.42 + 0.16 SDS (p = 0.03)) and a non- significant decrease in the controls (-0.18 + 0.11SDS) (difference between groups p= 0.02). Change in BMD did not differ significantly between the groups, although the increase in BMD for lumbar spine within the hGH- group was significant. Lean body mass improved significantly in the hGH-group compared to control (0.64 + 0.19 SDS versus -0.20 + 0.17 SDS (p<0,01)), while the decrease in percentage fat was not significant.

Conclusions:A significant effect of hGH on growth and lean body mass was seen, but a longer duration of treatment might be necessary to evaluate the effect of hGH on BMD.

Keywords: body composition, glucocorticoids, growth disorders, growth hormone, rheumatic diseases

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