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The reduction of bone mineral density in postmenopausal women with primary hyperparathyroidism is higher in the presence of concomitant GH secretion impairment

Department of Endocrinology and Metabolism, University of Pisa, Ospedale, Cisanello, Via Paradisa 2, 56124 Pisa, Italy, ¹ Division of Endocrinology, University of Turin, Turin, Italy and ² Chair and Division of Endocrinology, University of Insubria, 21100 Varese, Italy

(Correspondence should be addressed to M Gasperi; Email: mgasperi{at}endoc.med.unipi.it)

Objective: To investigate, in a large group of postmenopausal primary hyperparathyroidism (PHP) women, whether the concomitance of GH deficiency (GHD) may contribute to the development of changes in bone mineral density (BMD).

Design: GH secretion, bone status and metabolism were investigated in 50 postmenopausal women with PHP and in a control group of 60 women with no evidence of PHP, matched for age, age at menopause and body mass index (BMI).

Methods: GH response to growth hormone-releasing hormone (GHRH)+arginine (Arg), femoral neck BMD (g/cm²) by dual energy X-ray absorptiometry, BMI, serum-ionized calcium, parathyroid hormone (PTH) and markers of bone remodelling were evaluated in all patients and controls.

Results: Among PHP patients, GH secretion was reduced (8.8 ± 4.2 µg/l, range 1.1–16.5 µg/l) in 34 patients and normal (28.7 ± 11.8 µg/l, range 17.9–55.7 µg/l) in the remaining 16 (P < 0.05), no women in the control group had GHD (peak GH 33.8 ± 10.9 µg/l, range 21.7 ± 63.2 µg/l). Osteoporosis (T-score < – 2.5) and osteopenia (T-score > –2.5 and < –1) were found in 73.5 and 17.6% of GHD patients, in 37.5 and 43.7% of patients with normal GH secretion and 3.1 and 27% of controls. T-score and BMD were not correlated with ionized calcium, age, age at menopause, BMI, GH peak and IGF-I but were correlated with serum PTH levels in both groups. T-score was correlated with serum levels of markers of bone remodelling only in PHP patients with GHD.

Conclusions: Concomitant impairment of GH secretion may play a pathogenetic role in the occurrence of changes in bone mass observed in PHP and contribute to make them more severe.