GH treatment and its effect on bone mineral density, bone maturation and growth in short children born small for gestational age: 3‐year results of a randomized, controlled GH trial
- 20 November 2003
- journal article
- research article
- Published by Wiley in Clinical Endocrinology
- Vol. 59 (6), 779-787
- https://doi.org/10.1046/j.1365-2265.2003.01905.x
Abstract
Background To investigate in a group of short children born small for gestational age (SGA), the effects of 3 years of GH treatment vs. no treatment on bone age (BA), height and bone mineral density (BMD). Also, to evaluate the influence of the severity of growth retardation at start and the GH dose on the gain in height. patients and methods The study design was an open‐labelled, controlled multicentre GH study for 3 years. Non‐GH‐deficient (GHD) children (n = 87) were randomized to either a GH group (n = 61) or an untreated control group (n = 26). In addition, 12 SGA children had GHD (GHD group) and were treated in parallel. Both the GH and the GHD group were treated with a GH dose of 33 µg/kg/day. BMD was evaluated using dual energy X‐ray absorptiometry (DEXA). In addition, data of our first GH trial in which short SGA children were treated with a GH dose of 66 µg/kg/day (n = 24) were used for comparison of height gain. results In contrast to the control group, the GH group showed a significant increase in height (P < 0·001), as did the parallel GHD group. Bone maturation [Δ bone age (BA)/Δ calendar age (CA)] increased significantly during the first 2 years of GH treatment but slowed‐down thereafter. The 3‐year ΔBA/ΔCA ratio correlated significantly with the gain in height (r = 0·6, P < 0·001). At start, mean BMD SDS and mean BMAD SDS were significantly lower than zero. During GH treatment both increased impressively (P < 0·001). The gain in height of children with severe short stature at start (≤ −3·00 SDS), did not differ between those receiving either a GH dose of 33 or 66 µg/kg/day. conclusion Three years of GH treatment in short children born SGA results in a normalization of height during childhood. Also, bone maturation increased proportionately to the height gain. At start, mean values of BMD and BMAD were significantly reduced but normalized during GH treatment. We did not find an indication to treat very short SGA children (H SDS ≤−3·00) with a higher GH dose. We rather suggest to start GH treatment at an early age in order to achieve a normal height before puberty starts.Keywords
This publication has 33 references indexed in Scilit:
- Plasma Levels of Insulin-Like Growth Factor (IGF)-I, IGF-II and IGF-Binding Protein-3 in the Evaluation of Childhood Growth Hormone DeficiencyHormone Research in Paediatrics, 1998
- Changes in serum insulin-like growth factor I (IGF-I) and IGF-binding protein-3 levels during growth hormone treatment in prepubertal short children born small for gestational ageJournal of Clinical Endocrinology & Metabolism, 1996
- Growth and symptoms in Silver-Russell syndrome: Review on the basis of 386 patientsEuropean Journal of Pediatrics, 1995
- Spontaneous 24-hour growth hormone profiles in prepubertal small for gestational age childrenJournal of Clinical Endocrinology & Metabolism, 1995
- Comparison of different models for interpreting bone mineral density measurements using DXA and MRI technologyBone, 1995
- Normalization of spine densitometryJournal of Bone and Mineral Research, 1994
- Natural growth in children born small for gestational age with and without catch‐up growthActa Paediatrica, 1994
- Adolescent growth and pubertal progression in the Silver-Russell syndrome.Archives of Disease in Childhood, 1988
- Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty.Archives of Disease in Childhood, 1976
- Intrauterine growth of live-born Caucasian infants at sea level: Standards obtained from measurements in 7 dimensions of infants born between 25 and 44 weeksThe Journal of Pediatrics, 1969