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The Effect of Growth Hormone (GH) on Histomorphometric Indices of Bone Structure and Bone Turnover in GH-Deficient Men

Department of Endocrinology (N.B., H.d.B., E.A.v.d.V., P.L.), and Department of Nuclear Medicine (J.C.R.), Academic Hospital Vrije Universiteit, 1007 MB Amsterdam, The Netherlands; and Department of Oral Cell Biology (P.H.), Academic Center of Dentistry, 1081 BT Amsterdam, The Netherlands

Address all correspondence and requests for reprints to: P. Lips, Department of Endocrinology, Free University Hospital, PO Box 7057, 1007 MB Amsterdam, The Netherlands.

We investigated the effects of GH on bone structure and turnover by histomorphometry in GH-deficient adults. Therefore, transiliac bone biopsies were obtained before and after 1 yr of treatment in 36 GH-deficient men (mean age, 28 ± 4 yr). Thirteen patients had isolated GH deficiency and 23 patients had multiple pituitary hormone deficiencies. Patients were randomly assigned to four treatment groups. Groups 1, 2, and 3 received 1, 2, and 3 IU/m²/day (2.9, 5.0, and 8.7 mg/m²/day) GH, respectively, and the fourth group received placebo for the first 6 months and 2 IU/m²/day (5.8 mg/m²/day) GH for the subsequent 6 months. GH treatment resulted in an increase of cortical thickness from 0.98 ± 0.27 to 1.20 ± 0.35 mm (P = 0.005), but trabecular bone volume did not change. Bone formation variables increased significantly: osteoid surface increased from 8.5 ± 5.3 to 15.5 ± 6.1% (P = 0.0002), mineralizing surface increased from 6.7 ± 2.5 to 10.8 ± 4.4% (P = 0.0002), and bone formation rate increased from 0.04 ± 0.02 to 0.08 ± 0.04 mm³/mm²/day (P = 0.0001). Eroded surface did not change, but osteoclast number increased from 0.6 ± 0.5 to 1.25 ± 0.5 Oc/mm² (P = 0.0001). The relative formation period increased significantly (P = 0.001), whereas the resorption period, including reversal phase, decreased from 65 to 40 days (P = 0.02). Activation frequency increased from 0.39 ± 0.17 to 0.74 ± 0.34 y^-1 (P = 0.0001). These data indicate a stimulated bone turnover as a result of GH treatment and a shorter resorption and reversal time. The increased turnover did not result in an increased trabecular bone volume, but the cortical thickness increased significantly.

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