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Longitudinal Follow-Up of Bone Density and Body Composition in Children with Precocious or Early Puberty before, during and after Cessation of GnRH Agonist Therapy

Department of Pediatrics (I.M.v.d.S., A.M.B., S.L.S.D., S.M.P.F.d.M.K.-S.), Subdivision of Endocrinology, Sophia Children’s Hospital, 3015 GJ Rotterdam, The Netherlands; and Departments of Radiology (I.M.v.d.S.) and Nuclear Medicine (E.P.K.), Dijkzigt Hospital, Erasmus University, 3015 GD Rotterdam, The Netherlands

Address all correspondence and requests for reprints to: Inge van der Sluis, M.D., Sophia Children’s Hospital, Subdivision of Endocrinology, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands. E-mail: vandesluis{at}alkg.azr.nl

Abstract

We studied bone mineral density (BMD), bone metabolism, and body composition in 47 children with central precocious puberty (n = 36) or early puberty (n = 11) before, during, and after cessation of GnRH agonist. Bone density and body composition were measured with dual energy x-ray absorptiometry and expressed as SD scores. Bone age and biochemical parameters of bone turnover were assessed. Measurements were performed at baseline, after 6 months, and on a yearly basis thereafter.

Mean lumbar spine BMD SD scores for chronological age were significantly higher than zero at baseline and decreased during treatment. Lumbar spine bone mineral apparent density and total body BMD did not differ from normal at baseline and showed no significant changes during treatment. In contrast, BMD SD scores for bone age were significantly lower than zero at baseline and at cessation of therapy. Two years after therapy, bone mineral apparent density and BMD SD scores for bone age and chronological age did not differ from normal. Markers of bone turnover decreased during treatment, mainly in the first 6 months. Patients had increased percentage of fat and lean body mass at baseline. After an initial increase of percentage body fat during treatment, percentage body fat decreased and normalized within 1 yr after cessation of treatment.

Our longitudinal analysis suggests that peak bone mass or body composition will not be impaired in patients with precocious or early puberty after GnRH agonist therapy.

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