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Effect of GnRH analogue on the bone mineral density of precocious or early pubertal girls

Korean Journal of Pediatrics 2009;52(12):1370-1376.
Published online December 15, 2009.
Effect of GnRH analogue on the bone mineral density of precocious or early pubertal girls
Jeong Sook Lim, Heon-Seok Han
Department of Pediatrics, Chungbuk National University, College of Medicine, Cheongju, Korea
성조숙증 혹은 조기 사춘기가 있는 여아에서 단기간의 성선자극호르몬 방출호르몬 효능약제 사용이 골밀도에 미치는 영향
임정숙, 한헌석
충북대학교 의과대학 소아과학교실
Correspondence: 
Heon-Seok Han, Email: hshan@chungbuk.ac.kr
Abstract
Purpose
: Treatment of precocity with gonadotropin releasing hormone analogue (GnRHa) might theoretically exert a detrimental effect on the bone mass during pubertal development. We investigated the short-term changes in bone mineral density (BMD) during GnRHa treatment and the enhancement in the changes with the co-administration of GnRHa and human growth hormone (hGH).
Methods
: Forty girls with precocious or early puberty who were using GnRHa for more than 1 year were enrolled. Of them, 14 concurrently received hGH. Lumbar bone mineral density was measured before and after the treatment, and bone mineral density-standard deviation scores (BMD-SDSs) were compared according to chronologic age (CA) and bone age (BA), as well as according to the administration of GnRHa alone (Group I) or the co-administration of hGH and GnRHa (Group II).
Results
: BMDs before and after treatment were in the normal range according to CA but were significantly lower according to BA (P<0.05). During treatment, BMD-SDSs did not change according to CA but significantly increased according to BA (P<0.05). BMD-SDSs in group I did not change during treatment according to CA or BA, while those in group II increased significantly according to BA (P<0.05), but not according to CA.
Conclusion
: Lumbar BMD was adequate according to CA at initial manifestation of precocity but was lower if compared to BA, that is, BMD did not increase with BA. Because co-treatment with hGH significantly increased BMD-SDSs according to BA, hGH co-treatment could be considered during GnRHa therapy.
Key Words: Precocious puberty, Bone density, Gonadotropin releasing hormone, Human growth hormone


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