Abstract
Growth hormone and bone both directly and indirectly via increased production of insulin-like growth factor (IGF-1) in the liver and locally in bone. Anabolic effects predominate due to stimulation of osteoblasts proliferation and function and increase of tissue sensitivity to parathyroid hormone in bone and other tissues.
Growth hormone insufficiency leads to decrease of bone mass in some patients; however osteoporosis is not indication for growth hormone replacement. More evident is increased fracture incidence with growth hormone insufficiency and its improvement on substitution therapy.
Improvement of bone density and increase of muscle mass and force plays the role. In the case of severe osteoporosis combination therapy with growth hormone and bisphosphonates or phosphate is indicated.
In acromegalic patients increased incidence of vertebral fractures is reported without relation to disease activity and bone mass.