The infuence of growth hormone deficiency, growth hormone replacement therapy, and other aspects of hypopituitarism on fracture rate and bone mineraldensity

To assess the influence of factors affecting fracture risk and bone density in adult hypopituitary patients with growth hormone deficiency (GBD), data from a large-scale pharmacoepidemiological survey (the Pharmacia Upjohn In ternational Metabolic Database [KIMS]) were analyzed and compared with data from a control population (the European Vertebral Osteoporosis Study [EVOS ]). The KIMS group consisted of 2084 patients (1112 men and 972 women) with various types of pituitary disease and EVOS consisted of 1176 individuals (581 men and 595 women). Fracture and bone mineral density (BMD) data were available from 2024 patients from the KIMS group and 392 patients from EVOS . The prevalence of fractures in patients with hypopituitarism was 2.66 tim es that in the non-GH-deficient EVOS population. Adult-onset hypopituitaris m with GHD was associated with a higher fracture risk than childhood-onset disease, and patients with isolated GHD had a similar prevalence of fractur es to those with multiple pituitary hormone deficiencies, Hormonal replacem ent therapy with L-thyroxine, glucocorticoids, and sex steroids did not aff ect the risk of fracture in KIMS patients. In addition, fracture rates in K IMS were independent of body mass index (BMI) and the country of origin. Ho wever, smoking was associated with a higher fracture rate in this group. In summary, this is the first large-scale analysis to support the hypothesis of an increased fracture risk in adult patients with hypopituitarism and GH D. This increased risk appears to be attributable to GHD alone, rather than to other pituitary hormone deficiencies or to their replacement therapy.