Fractures in pituitary adenoma patients from the Dutch National Registry of Growth Hormone Treatment in Adults

N. C. van Varsseveld, C. C. van Bunderen, A. A M Franken, H. P F Koppeschaar, A. J. van der Lely, M. L. Drent

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11 Citations (Scopus)


Purpose: The effects of growth hormone (GH) replacement therapy on fracture risk in adult GH deficient (GHD) patients with different etiologies of pituitary GHD are not well known, due to limited data. The aim of this study was to investigate characteristics and fracture occurrence at start of (baseline) and during long-term GH replacement therapy in GHD adults previously treated for Cushing’s disease (CD) or acromegaly, compared to patients with previous nonfunctioning pituitary adenoma (NFPA). Methods: From the Dutch National Registry of Growth Hormone Treatment in Adults, a nationwide surveillance study in severe GHD adults, all patients using ≥30 days of GH replacement therapy with previous NFPA (n = 783), CD (n = 180) and acromegaly (n = 65) were selected. Patient characteristics, fractures and potential influencing factors were investigated. Results: At baseline, patients with previous CD were younger, more often female and had more often a history of osteopenia or osteoporosis, whereas patients with previous acromegaly had more often received cranial radiotherapy and a longer duration between treatment of their pituitary tumor and start of adult GH replacement therapy. During follow-up, a fracture occurred in 3.8 % (n = 39) of all patients. Compared to patients with previous NFPA, only patients with previous acromegaly had an increased fracture risk after 6 years of GH replacement therapy. Conclusions: During GH replacement therapy, an increased fracture risk was observed in severe GHD adult patients previously treated for acromegaly, but not in those previously treated for CD, compared to severe GHD adult patients using GH replacement therapy because of previous NFPA. Further studies are needed to confirm these findings and to elucidate potential underlying mechanisms.

Original languageEnglish
Pages (from-to)381-390
Number of pages10
Issue number4
Publication statusPublished - 1 Aug 2016


  • Absorptiometry, Photon
  • Acromegaly
  • Adenoma
  • Adult
  • Aged
  • Bone
  • Bone Diseases, Metabolic
  • Cranial Irradiation
  • Cushing’s disease
  • Female
  • Fractures
  • Fractures, Bone
  • Growth Hormone-Secreting Pituitary Adenoma
  • Growth hormone
  • Growth hormone deficiency
  • Hormone Replacement Therapy
  • Human Growth Hormone
  • Humans
  • Hypopituitarism
  • Journal Article
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Netherlands
  • Nonfunctioning pituitary adenoma
  • Osteoporosis
  • Osteoporotic Fractures
  • Pituitary ACTH Hypersecretion
  • Pituitary Gland
  • Pituitary Neoplasms
  • Proportional Hazards Models
  • Recombinant Proteins
  • Registries
  • Risk Factors
  • Severity of Illness Index

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