Bone Mineral Density and Body Composition in Short Children Born SGA during Growth Hormone and Gonadotropin Releasing Hormone Analog Treatment

Context: Postponement of puberty by GnRH analog (GnRHa) in addition to GH treatment might increase adult height (AH) in short adolescents born small for gestational age (SGA). GnRHa treatment is thought to have negative effects on bone mineral density (BMD) and body composition. Objective: The objective of the study was to assess the BMD of total body (BMDTB), lumbar spine (BMDLS), bone mineral apparent density lumbar spine (BMADLS), lean body mass, fat mass, and fat distribution during GH treatment, with or without an additional 2 yr of GnRHa. Patients and Design: This was a prospective GH trial involving short SGA adolescents (≥8 yr). Eighty-eight children (50 girls) were treated until AH (GH randomized 1 or 2 mg/m2 · d during puberty); 52 of these children received additional GnRHa. BMD and body composition were longitudinally assessed by dual-energy X-ray absorptiometry. Results: Baseline BMDTB sd score (SDS) and BMDLS SDS were significantly reduced (both P < 0.001), but BMADLS SDS was comparable with zero (P = 0.129). BMDTB SDS and BMDLS SDS improved (both P < 0.001) from the start until AH, whereas BMADLS SDS remained similar (P = 0.168). At AH, 93% of patients had a normal BMDTB, 99% a normal BMDLS, and 98% a normal BMADLS (> −2 and < +2 SDS). From the start until AH, lean body mass SDSheight and fat mass SDS increased significantly toward zero (both P