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

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/cm(2)) 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 mu g/l, range 1.1-16.5 mu g/l) in 34 patients and normal (28.7 +/- 11.8 mu g/l, range 17.9-55.7 mu g/l) in the remaining 16 (P < 0.0 5), no women in the control group had GHD (peak GH 33.8 +/- 10.9 mu g/l, range 21.7 +/- 63.2 mu g/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 2 7% of controls. T-score and BMD were not correlated with ionized calcium, age, age at menopause, BMI, GH peak and IGF-1 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.