Randomized controlled trial to investigate the effects of growth hormone treatment on scoliosis in children with prader-willi syndrome
Context: The prevalence of scoliosis in children with Prader-Willi syndrome (PWS) is 30-80%, depending on age. Although reports about effects of GH treatment on scoliosis in children with PWS are limited, scoliosis is generally considered a contraindication for GH treatment. Objective: The aim was to study the effects of GH treatment on the onset of scoliosis and curve progression in children with PWS. Design: We conducted a multicenter, randomized, controlled GH study in infants and prepubertal and pubertal children. Infants and prepubertal children were randomized into a GH-treated group (1.0 mg/m2 · d) and a control group for 1 and 2 yr, respectively. Pubertal children were randomized to receive somatropin 1.0 or 1.5 mg/m2 · d. Yearly, x-rays of the spine were taken, and height, weight, truncal lean body mass (with dual energy x-ray absorptiometry), and IGF-I were measured. Patients: A total of 91 children with PWS (median age, 4.7 yr; interquartile range, 2.1-7.4) participated in the study. Main Outcome Measures: We measured the onset of scoliosis (Cobb <10°) and scoliotic curve progression. Results: GH-treated children had similar onset of scoliosis and curve progression as randomized controls (P = 0.27-0.79 and P = 0.18-0.98, respectively). GH treatment, IGF-I sd score (SDS), and catch-up growth had no adverse effect on the onset of scoliosis or curve progression, even after adjustment for confounders. Height SDS, truncal lean body mass, and IGF-I SDS were significantly higher in GH-treated children than in randomized controls. At baseline, a higher IGF-I SDS was associated with a lower severity of scoliosis. Conclusions: Scoliosis should no longer be considered a contraindication for GH treatment in children with PWS.
|Keywords||Prader Willi syndrome, adolescent, article, catch up growth, child, clinical trial, controlled clinical trial, controlled study, disease severity, drug effect, dual energy X ray absorptiometry, female, human, human growth hormone, infant, lean body weight, major clinical study, male, multicenter study, outcome assessment, preschool child, priority journal, randomized controlled trial, school child, scoliosis, somatomedin C|
|Persistent URL||dx.doi.org/10.1210/jc.2008-1844, hdl.handle.net/1765/16430|
de Lind van Wijngaarden, R.F.A., Klerk, L.W.L., Festen, D.A.M., Duivenvoorden, H.J., Otten, B.J., & Hokken-Koelega, A.C.S.. (2009). Randomized controlled trial to investigate the effects of growth hormone treatment on scoliosis in children with prader-willi syndrome. Journal of Clinical Endocrinology and Metabolism, 94(4), 1274–1280. doi:10.1210/jc.2008-1844