REPLY
Growth Hormone and Function in Elderly Persons
Maxine A. Papadakis, MD
1 April 1997 | Volume 126 Issue 7 | Pages 583-584
IN RESPONSE:
Feller and colleagues point out that growth hormone replacement in growth hormone-deficient younger adults results in improved strength. On the basis of these data, they suggest that the effect of growth hormone on muscle strength remains unresolved. We question the extent to which these data from younger adults with pathologically low growth hormone levels can be generalized to healthy older men with physiologic declines in growth hormone levels. Our participants were elderly (mean age, 75.0 years) and had low baseline IGF-1 levels (122 ng/mL) but were not frail. Thus, we have no data with which to assess the efficacy of growth hormone replacement in the frail elderly. However, we believe that the likely side-effect profile in frail older persons is worrisome.
Feller and colleagues also question whether we used the optimum dose of recombinant growth hormone. The dose used in our study (0.03 mg/kg of body weight three times a week) was the same as the dose Feller and associates used in their original study of recombinant growth hormone replacement in older men [1]. We have no data with which to assess the effect of different doses of recombinant human growth hormone on muscle strength, but we found no correlation between baseline plasma IGF-1 levels and muscle strength [2] or between change in plasma IGF-1 levels after 6 months of replacement and change in muscle strength.
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Author and Article Information
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Department of Veterans Affairs Medical Center, San Francisco, CA 94121
1. Rudman D, Feller AG, Nagraj HS, Gergans G, Lalitha PY, Goldberg AF, et al. Effects of human growth hormone in men over 60 years old. N Engl J Med. 1990; 323:1-9.
2. Papadakis MA, Grady D, Tierney MJ, Black D, Wells L, Grunfeld C. Insulin-like growth factor 1 and functional status in healthy older men. J Am Geriatr Soc. 1995; 43:1350-5.
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