Use of a Gonadotropin-releasing Hormone Analog to Treat Idiopathic Central Precocious Puberty Is Not Associated with Changes in Bone Structure in Postmenarchal Adolescents - 15/06/15

Doi : 10.1016/j.jpag.2014.09.002

Renata Iannetta, PhD, MD ¹, Anderson S. Melo, PhD, MD ¹, Odilon Iannetta, PhD, MD ¹, Júlio S. Marchini, PhD, MD ², Francisco J. Paula, PhD, MD ², Carlos E. Martinelli, PhD, MD ³, Ana Carolina J.S. Rosa e Silva, PhD, MD ¹, Rui A. Ferriani, PhD, MD ¹, Wellington P. Martins, PhD, MD ¹, Rosana M. Reis, PhD, MD ^1,^⁎
¹ Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo
² Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo
³ Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo

^∗Address for correspondence to: Rosana Maria dos Reis, PhD, MD, Avenida dos Bandeirantes 3900, Campus da USP, Ribeirão Preto–SP CEP, São Paulo, Brazil 14049-900; Phone: +55 16 3602 2926

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 15 June 2015

Abstract

Study Objectives

To evaluate bone quantity and quality in postmenarchal adolescents treated for idiopathic central precocious puberty (CPP) in childhood with a gonadotropin-releasing hormone analog (GnRHa) and to determine the serum concentrations of bone remodeling markers.

Design and Participants

This cross-sectional study included 53 postmenarchal adolescent girls who were divided into 2 groups: 27 adolescents who were treated with GnRHa in childhood for idiopathic CPP (the CPP group) and 26 women who presented with physiological development of secondary sex traits (the control group). Interventions: None.

Main Outcome Measures

Weight, height, body mass index, age at menarche, time since menarche, body composition, bone mineral density (BMD), bone quality, and serum insulin, glucose, osteocalcin, and carboxyl-terminal telopeptide of type I collagen concentrations were compared in the 2 groups. BMD data were analyzed by using both dual-energy x-ray absorptiometry (DXA) and osteosonography, and body composition was measure with the use of DXA and electrical bioimpedance.

Results

BMD and bone quality did not differ significantly between the CPP and control groups when analyzed by using DXA or osteosonography. Serum osteocalcin concentration was significantly lower (P = .02) in the CPP than in the control group. Insulin was higher in the CPP group, and hyperinsulinemia was an independent predictor of bone quantity and quality assessed by using osteosonography. Body mass index and percent fat were determined by using DXA, and the duration of use of GnRHa treatment and the time since GnRHa discontinuation were not independent predictors of bone quantity and quality.