Bone mineral density in young adults with Prader-Willi syndrome: a randomized, placebo-controlled, cross-over GH trial

Summary

Context

The prevalence of osteoporosis is increased in adults with Prader-Willi syndrome (PWS). In children with PWS, growth hormone (GH) treatment has beneficial effects on bone mineral density (BMD). BMD might deteriorate after cessation of GH at adult height (AH), while continuing GH might maintain BMD.

Objective

To investigate the effects of GH versus placebo, and furthermore the effects of sex steroid replacement therapy (SSRT), on BMD in GH-treated young adults with PWS who had attained AH.

Design

two-year, randomized, double-blind, placebo-controlled, cross-over GH study.

Patients

27 young adults with PWS, stratified for gender and BMI. All patients were randomly and blindly assigned to receive GH (0.67 mg/m²/day) and placebo, both during one year.

Measurements: Bone mineral density of the total body (BMD_TB) and lumbar spine (BMD_LS) SDS, measured by dual energy x-ray absorptiometry.

Results

At AH, BMD_TBSDS was significantly lower compared to healthy peers (p<0.01), while BMAD_LSSDS was similar. Both BMD_TBSDS and BMAD_LSSDS were similar during one year of GH versus one year of placebo. In hypogonadal young adults without SSRT, BMD_TBSDS and BMAD_LSSDS decreased during the two-year study (p=0.11 and p=0.01), regardless of GH or placebo, while BMD_TBSDS increased in those with SSRT (p<0.01).

Conclusions

Compared to GH treatment, one year of placebo after attainment of AH does not deteriorate BMD SDS in young adults with PWS. In addition, our data suggest that GH is not able to prevent the decline in BMD SDS in hypogonadal young adults with PWS, unless it is combined with SSRT.

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