The effects of growth hormone (GH) on bone mass are still controversial. Simon et al. observed that in 14 children treated for 1 year with GH and followed for two more years after stopping it, height velocity and height as well as lean mass increased significantly during the year on GH, but fell to pre-treatment values after withdrawal (67). A significant increase in bone turnover was also observed in 14 children with systemic JIA on long-tem steroid therapy, treated with GH for one year (68). Bone turnover returned to the pre-GH velocity after discontinuation of the growth hormone. A not significant increase in bone mass was observed.
Bechtold and colleagues followed 11 children with JIA treated with GH for 4 years, and did not find statistically significant improvement of vBMD (BMD corrected for vertebral size) (69).
On the contrary, an increase of bone mineral content, correlated with increasing height, was observed in 20 children with severe JIA, 17 of whom were on corticosteroid treatment (70). Positive results (lumbar BMD increase by 36.6%) were also observed in 13 JIA patients treated with GH for 3 years (71).
On the basis of these contradictory results, it is clear that long-term controlled studies are needed to determine the real impact of GH therapy on bone mass and bone turnover. It should also be considered that GH must be given almost every day by injection, is expensive, not free of potential side-effects, and there are legal limitations to its prescription in several countries.
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