Longitudinal assessment of bone health index as a measure of bone health in short-statured children before and during treatment with recombinant growth hormone

Abstract

Abstract Objectives The aim of our study was the longitudinal assessment of bone health index (BHI) in short-statured children during growth hormone (GH) treatment to estimate changes in their bone health. Methods 256 short-statured children (isolated GH deficiency (IGHD) n=121, multiple pituitary hormone deficiency (MPHD) n=49, intrauterine growth retardation (small for gestational age (SGA)) n=52, SHOX (short stature homeobox gene) deficiency n=9, Ullrich Turner syndrome (UTS) n=25) who started with GH between 2010 and 2018 were included. Annual bone ages (Greulich and Pyle, GP) and BHI were, retrospectively, analysed in consecutive radiographs of the left hand (BoneXpert software) from GH therapy start (T0) up to 10 years (T10) thereafter, with T max indicating the individual time point of the last available radiograph. The results are presented as the median (25 %/75 % interquartile ranges, IQR) and statistical analyses were performed using non-parametric tests as appropriate. Results The BHI standard deviation scores (SDS) were reduced (−0.97, −1.8/−0.3) as bone ages were retarded (−1.6 years, −2.31/−0.97) in all patients before start of GH and were significantly lower in patients with growth hormone deficiency (GHD) (−1.04, −1.85/−0.56; n=170) compared to non-GHD patients (−0.79, −1.56/−0.01; n=86; p=0.022). BHI SDS increased to −0.17 (−1/0.58) after 1 year of GH (T1, 0.5–1.49, p<0.001) and to −0.20 (−1/−0.50, p<0.001) after 5.3 years (T max, 3.45/7.25). Conclusions BHI SDS are reduced in treatment-naive short-statured children regardless of their GH status, increase initially with GH treatment while plateauing thereafter, suggesting sustained improved bone health.