Malnourished anorexia nervosa patients receiving growth hormone have increased serum markers of bone formation

Osleopcnia complicating anorexia nervosa (AN) is associated with spine and stress fractures and may not be reversible later in life. Bone loss correlates with amenorrhea but estrogen therapy is not effective in correcting bone loss. Weight gain improves bone mass. Recombinant human growth hormone (rhGH) can promote a positive nitrogen balance and weight gain in malnourished surgical and AIDS patients. It is our hypothesis that rhGH treatment can augment bone formation in AN patients requiring inpatient enterai nutritional support. Fifteen malnourished (<80% of ideal body weight) AN patients, ages 12-18 years (14 females/1 male), mean body mass index (BM1) 14.5 kg/M2 were enrolled into a 28 day randomized, double blind, placebo-controlled study. Patients received either rhGH (0.05 mg/kg s.q. daily) or placebo during hospitalization for enterai nutritional support. Bone turnover was assessed by serum levels of type 1 procollagen carboxyterminal propeptide (PICP-marker of hone formation) and type 1 collagen carboxyterminal telopeptide (ICTPtnarker of bone résorption) measured using radioimmunoassay. The rhGH and placebo groups did not differ significantly in admission weight, BMI, daily caloric intake or weight gain (4.8±1.3 kg for rhGH vs 4.0±3.0 kg for placebo). Initial mean PICP levels were in the normal range for both groups (160±84 for rhGH, 138±48 for placebo, normal: 50-170 ng/ml) and increased with treatment and weight gain (248±78 for rhGH and 172±62 for placebo); however, only the rhGH treated group's increase in PICP level was statistically significant (p<0.05). Both groups had increased ICTP levels prior to treatment (15.6±11.2 for rhGH. 15.67.9 for placebo, normal: 1.8-5.0 g/ml) which did not change significantly (13.3+4.1 for rhGH and 10.33.6 for placebo). To the extent that PICP reflects bone formation, AN patients treated with rhGH have greater new bone formation than occurs with weight gain alone. Further studies are needed to confirm the clinical relevance of our finding that osteoblastic activity (as reflected in PICP levels) is improved with rhGH. There may be a role for rhGH in nutritional support of AN patients.