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- Title
Growth hormone and testosterone delay vertebral fractures in boys with muscular dystrophy on chronic glucocorticoids.
- Authors
Loscalzo, Emely; See, Julia; Bharill, Sonum; Yousefzadeh, Nazanin; Gough, Ethan; Wu, Malinda; Crane, Janet L.
- Abstract
Summary: Glucocorticoid use in Duchenne and Becker muscular dystrophy prolongs ambulation but cause significant skeletal toxicity. Our analysis has immediate clinical implications, suggesting that growth hormone and testosterone have a stronger effect prior to first and subsequent vertebral fracture, respectively, relative to bisphosphonates alone in children with dystrophinopathies on chronic glucocorticoids. Purpose: Glucocorticoids prolong ambulation in boys with Duchenne muscular dystrophy; however, they have significant endocrine side effects. We assessed the impact of growth hormone (GH), testosterone, and/or zoledronic acid (ZA) on vertebral fracture (VF) incidence in patients with dystrophinopathies on chronic glucocorticoids. Methods: We conducted a longitudinal retrospective review of 27 males with muscular dystrophy. Accelerated failure time (AFT) models were used to estimate the relative time to VF while on GH, testosterone, and/or ZA compared to ZA alone. Results are reported as failure time ratio, where >1 indicates prolonged time versus <1 indicates shorter time to next VF. Results: The prevalence of growth impairment was 96% (52% utilized GH), pubertal delay was 86% (72% utilized testosterone), and low trauma fractures were 87% (72% utilized ZA). Multivariable analysis of the AFT models showed that participants on either GH or testosterone treatment relative to ZA alone experienced prolonged time to next VF (1.253, P<0.001), with GH being the significant contributor when analyzed independently from testosterone (1.229, P<0.001). Use of ZA with GH or testosterone relative to ZA alone resulted in prolonged time to next VF (1.171, P<0.001), with testosterone being a significant contributor (1.130, P=0.033). Conclusion: GH and testosterone each decreased VF risk in patients independent of or in combination with ZA, respectively.
- Subjects
MARYLAND; THERAPEUTIC use of testosterone; MUSCULAR dystrophy treatment; GLUCOCORTICOIDS; MEN'S health; MULTIVARIATE analysis; DELAYED puberty; RETROSPECTIVE studies; ACQUISITION of data; HUMAN growth hormone; COMPARATIVE studies; MEDICAL records; DISEASE prevalence; WALKING; DESCRIPTIVE statistics; VERTEBRAL fractures; LONGITUDINAL method
- Publication
Osteoporosis International, 2024, Vol 35, Issue 2, p327
- ISSN
0937-941X
- Publication type
Article
- DOI
10.1007/s00198-023-06951-z