Is there a link between scoliosis and growth hormones?

1. Is there a link between scoliosis and growth hormones? By Nasim Dariani

2. Background Information on Growth Hormones • Growth hormone is a protein-based peptide which stimulates growth, cell reproduction, and regeneration in humans and animals. • Growth hormone injections are used to treat children’s growth disorders/growth hormone deficiencies because their pituitary glands cannot produce the proper amount of growth hormones resulting in a short stature. • Basically, the hormone tells your bones and muscles to grow. • GHD(growth hormone deficiency) can occur in infancy or later in childhood. If detected early, the child can a reach a normal height. • GHD may be treated through growth hormone therapy, which your doctor must prescribe. Treatment consists of a daily injection of growth hormones until your doctor decides when to stop. • Side effects include of blurred vision, tingling sensation in skin, numbness, dizziness, ear infections, headaches, nausea, and vision changes. • Growth hormones also cause rapidgrowth which can lead to other problems. • For example, the progression of scoliosis can occur in children who experience rapid growth.

3. Growth Hormone Information Cont. Growth hormone therapy is often times given a bad name because of athletes who abuse the treatment. Also, some are beginning to use the treatment on healthy short children. According to Arthur Caplan, a bioethicist from University of Pennsylvania , “we’re beginning to accept artificial means to improve healthy children”. Even though growth hormone therapy is very controversial for some it can prove to be very helpful.

4. Growth Hormone Treatment Success Story • For 14 year old Michael Finley, height was important to him because he wanted to make his school’s basketball team. • Once tryouts came, Finley did not make the team despite his efforts and put the blame on his height. • Dr. Hardin, a pediatric endocrinologist, put Michael on growth hormones because he did not keep up with the growth curve and he had potential to grow based on his family’s stature. • In the course of a year, Michael grew 3 to 4 inches. • His doctor even estimates that he will grow to be 6 feet tall. • Overall, Michael and his family are very happy with the results and are glad they chose growth hormone therapy.

5. Background Information on Scoliosis Scoliosis is a disorder resulting in an abnormal curvature of the spine. People with scoliosis form a “C” or “S” shape in their spine. There is no cure for scoliosis and cause is unknown,but scoliosis is treatable. Treatments consists of early scoliosis screening, regular check-ups, wearing a back brace, and in extreme cases surgery Scoliosis is more common in girls than in boys and is hereditary. Doctors monitor scoliosis more cautiously during puberty because the body experiences rapid growth and the curve may worsen in times of rapid growth.

6. Types of Treatment for Scoliosis • A child with scoliosis should be monitored by his or her doctor every 4 to 6 months to check for any changes in the curvature of their spine. • If the child’s bones are still growing, the doctor may recommend a back brace. • The back brace will prevent the curve from progressing. • Braces are worn day and night and its effectiveness increases with the number of hours its worn.

7. Scoliosis Treatment Cont. In severe cases of scoliosis, your doctor may suggest surgery to prevent the curve from getting worse. Most common type of surgery is spinal fusion. Spinal fusion consists of surgeons connecting two or more bones in the spine together to prevent movement. Metal rods, hooks, and screws hold that part of the spine straight, while old and new bones fuse together. Spinal fusion surgery has a very high success rate and rarely is a second surgery needed.

8. Scoliosis Success Story (Amanda’s story) Amanda’s scoliosis was first detected when she was 13 years old. A year later her curve worsened and she needed surgery. Amanda feared that her days as an athlete would be put to an end or greatly limited. However, Amanda was proved wrong. According to her doctor, the operation went very well and post surgery, Amanda had minimal complaints. Amanda had even gained 3 inches to her height after the surgery. Amanda had a fast recovery and returned to school 5 weeks after her surgery. A few months later she was able to return to cheering, dancing, and doing gymnastics.

9. Cost of Treatments • Growth Hormone Therapy • Growth hormones are covered by insurance only if a doctor has prescribed them. • If not covered by insurance, hGH costs $150 per bottle and one may spend about $8,000 to $10,000 a year on medication and doctor visits. Scoliosis Scoliosis treatment is typically covered by insurance. If your insurance does not cover treatment it costs: Monitoring the curve: $3,386.25 (includes visits and x-rays, no treatment) Treatment with back brace: $10, 836.00 (does not include cost of brace) Back Brace: can range from $10,000 to $20,000 Surgery: $120,000

10. Is There a Link Between Scoliosis and Growth Hormones? According to the Foundation for Prader Willi Foundation growth hormone therapy does not worsen scoliosis. The incidence of scoliosis in Prader Willi Syndrome is very high. (80% in children over age 10) When growth hormone therapy became part of the treatment for PWS, one concern was the possibility of increasing the degree of curvature in the spine. (since scoliosis progresses during times of rapid growth) In fact, scoliosis is frequent in children with PWS who are receiving growth hormones.

11. Cont. However, this does not mean that growth hormones are the main cause of scoliosis. Even the studies that were conducted did not detect any difference in the severity of scoliosis regardless of whether GH therapy was used or not. In another article by Gregory A Day, titled Growth rates and the prevalence and progression of scoliosis in short-statured children on Australian growth hormone treatment programmes, the conclusion was that there was no evidence of HGH treatment responsible for the progression of scoliosis.

12. Cont. In this study, 185 patients were recruited and their dosage and frequency of growth hormone treatment were recorded. These patients were followed up over a 4 year period and the progression and severity of their scoliosis was recorded. The results showed that the growth rate of those with and without scoliosis were not statistically different and HGH treated was not ceased because of progression of scoliosis. In conclusion, in this study there was no evidence to show that HGH treatment is responsible for the progression of scoliosis.

13. On the Other Hand At the Children’s Hospital of Philadelphia, 250 children being treated with growth hormones were screened for scoliosis. In 10 of 250 patients, scoliosis developed. 6 of of those 10 patients had progressive curves and required an orthosis. Even after a brace, 3 of those patients needed spinal fusion surgery. In conclusion, growth hormones may increase the risk of rapid progression of scoliosis.

14. Final Answer There does not seem to be a definite answer as to whether there is a link between scoliosis and growth hormones. As you can see, some studies say there is not a link while one does say there is a link. I have come to the conclusion that growth hormones are not the main cause of scoliosis but they can have an impact on scoliosis. According to Genotropin, in children experiencing rapid growth, curvature of the spine may develop or worsen. Patients with scoliosis should be checked more cautiously to make sure their scoliosis does not worsen during growth hormone therapy.

15. Community Outreach For my community outreach aspect of the project, I emailed 2 organizations and conducted a survey. I heard back from the Scoliosis Research Society however they were unable to provide me with an answer as to if there is a link between scoliosis and growth hormones. Overall, the 51 people who took my survey displayed a strong understanding of scoliosis and growth hormones. For example, only 2/50 (1 skipped) did not know what scoliosis is. The general consensus for the answer to this question was scoliosis is the curvature of the spine. The next question more answered incorrectly than correctly. The correct answer was false, scoliosis only affects 2-3% of the population. Similarly more answered the following question incorrectly again. To my surprise as well, there is no cure to scoliosis. Scoliosis can only be treated not cured. For the last question concerning scoliosis, only 5 were unsure of scoliosis treatment. A majority said either a back brace or surgery and some even said growth hormones. It is interesting how some said growth hormones as a treatment for scoliosis because according to an article in the New York Times, one of the treatments listed is growth hormone therapy. Moving on to the questions about growth hormones, a majority answered both questions correctly. Lastly, 30 answered yes to if growth hormones increase the curvature of the spine whereas 20 said it does not.

16. True or False? Spinal fusion surgery can cost $200,000. People with scoliosis form an “S” or “Z” shape in their spine. Some side effects of growth hormone therapy consists of blurred vision, nausea, and vision changes. According to the Foundation for Prader Willi Foundation growth hormone therapy does worsen scoliosis.

17. Why I Chose This Question • I chose this question because I can easily relate to it. I was diagnosed with scoliosis when I was in fifth grade however the curve was small enough so I did not need any further treatment. However as I got older the curve began to progress and during that time I was also diagnosed with growth hormone deficiency, which meant I needed daily growth hormone injections. During the growth hormone treatment, the curve in my spine got progressively worse which required for me to wear a back brace for 20 hours a day. My parents decided to end the growth hormone injections as my spine worsened however it was too late and my back required surgery. After this incident, it led to me question if there is a correlation between growth hormones and scoliosis.

18. Work Cited “Growth Hormone Therapy Does Not Worsen Scoliosis." Foundation for Prader-Willi Research |. N.p., n.d. Web. 10 June 2013. "Health Guide." Scoliosis Treatment. N.p., n.d. Web. 10 June 2013. "Kids' Hormones: A Growth Industry." CBSNews. CBS Interactive, n.d. Web. 10 June 2013. Staff, Mayo Clinic. "Definition." Mayo Clinic. Mayo Foundation for Medical Education and Research, 03 Feb. 2012. Web. 10 June 2013. CANNING, ANDREA, and ALBERTO ORSO. "HGH -- Human Growth Hormone -- Injections Give Couple New Energy, Enjoyment of Life.” ABC News. ABC News Network, 09 Aug. 2011. Web. 10 June 2013. "Growth Rates and the Prevalence and Progression of Scoliosis in Short-statured Children on Australian Growth Hormone Treatment Programmes." Scoliosis. N.p., n.d. Web. 10 June 2013. "Result Filters." National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. 10 June 2013.