Growth Hormone & SCFE

The Effect of Human Growth Hormone Treatment on the Development of Slipped Capital Femoral Epiphysis: A Rigorous Cohort Analysis with 6 Years of Follow-up

IMPORTANCE Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents that can result in substantial complications, impacting quality of life. Growth hormone (HGH) administration may elevate the risk of SCFE, though the relationship remains unclear. Clarifying this association could enable better monitoring and earlier diagnosis of SCFE in patients receiving HGH.

OBJECTIVE To investigate the association between HGH administration and the incidence of SCFE. 

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study utilized multi-institutional EMR data from January 2003 to December 2022. The HGH cohort included 36,791 patients aged <18 years receiving growth hormone therapy followed for 6 years for development of SCFE, and a 1:1 propensity matched to a No-HGH cohort of patients not receiving growth hormone. 

EXPOSURE: Growth hormone administration.

MAIN OUTCOMES AND MEASURES: Development of SCFE, identified by ICD codes. Risk and hazard ratios calculated.

RESULTS: The HGH cohort had increased risk of SCFE compared to the No-HGH cohort (risk ratio: 3.5, 95% CI: 2.073, 5.909, P<0.001), and had increased hazard of developing SCFE (hazard ratio: 2.627, 95% CI: 1.555, 4.437, P<0.001). Patients with higher exposure to HGH (defined as >10 prescriptions) had a risk ratio of 1.914 (95% CI: 1.160, 3.159, P=0.010) when compared to their counterparts with <10 prescriptions. 

CONCLUSION: In the largest study to date, growth hormone administration was associated with an elevated risk of SCFE in children in a dose-dependent manner.