Effects of growth hormone therapy on bone in adults with osteopenia or osteoporosis and without growth hormone deficiency : a systematic review and meta-analysis -

Abstract

Background: Osteoporosis is a metabolic bone disease that constitutes both a significant personal burden as well as a major public health concern. Several alternatives are available to treat this disease through decrease in bone resorption. However, options are much more limited with regards to anabolic agents. Growth hormone (GH) is a peptide hormone normally produced by the pituitary gland. Studies have shown that GH plays an important role in bone metabolism. In adults, growth hormone deficiency (GHD) has been associated with low bone density and increased fracture risk, an effect that is counteracted by growth hormone replacement. Whether GH treatment can result in a similar benefit in adults with age-related bone loss, who presumably have age-related decline in GH, is unanswered.Objectives: The objectives of this systematic review and meta-analysis are: (1) Examine the effect of growth hormone therapy on bone densitometric endpoints, bone turnover markers and fracture risk in adults with osteopenia or osteoporosis and no organic growth hormone deficiency; (2) Evaluate the safety of growth hormone therapy in this population of interest. Search methodology: A systematic search of the existing literature was conducted using Medline, Embase and the Cochrane Register of Controlled Trials, without any time, language or study size restriction; the search was updated in November 2015. A manual search of the references of both original articles collected and pertinent review articles on the topic was also conducted. Eligibility criteria: We included prospective controlled trials conducted in postmenopausal women and men above the age of 50 years, with age-related osteopenia or osteoporosis and without organic growth hormone deficiency, in whom treatment with GH was used as compared to placebo or a comparator for at least six months. Data collection and analysis: Included trials were reviewed and data was collected from them as preplanned by two independent reviewers. We assessed risk of bias in retained randomiz