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

Mehul Mittal, David Momtaz, Rishi Gonuguntla, Aaron Singh, Dhyan Dave, Mahshid Mohseni, Beltran Torres-Izquierdo, Claire Schaibley, Pooya Hosseinzadeh

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Background: Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents that can result in substantial complications, impacting the quality of life. Human 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. The aim of the study is to investigate the association between HGH administration and the incidence of SCFE. Methods: This retrospective cohort study utilized data from the TriNetX research database from January 2003 to December 2022. The study included 2 cohorts: an HGH cohort including 36,791 patients aged below 18 years receiving HGH therapy and a control group consisting of patients who did not receive HGH therapy. A 1:1 propensity score matching technique was employed to ensure comparability between the HGH and no-HGH cohorts. The primary outcome measure was the development of SCFE identified by International Classification of Diseases codes. For comparative analysis, both risk ratios (RR) and hazard ratios were computed to evaluate the association between HGH therapy and the development of SCFE. Results: The HGH cohort had an increased risk of SCFE compared with the no-HGH cohort (RR: 3.5, 95% CI: 2.073, 5.909, P < 0.001) and had an 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 an RR of 1.914 (95% CI: 1.160, 3.159, P = 0.010) when compared with their counterparts with ≤ 10 prescriptions. Conclusions: In the largest study to date, HGH administration was associated with an elevated risk of SCFE in children in a dose-dependent manner.

Original languageEnglish
Pages (from-to)E344-E350
JournalJournal of Pediatric Orthopaedics
Issue number4
StatePublished - Apr 1 2024


  • SCFE
  • bone development
  • endocrinology
  • hormone therapy
  • human growth hormone
  • pediatric orthopaedics
  • skeletal growth
  • slipped capital femoral epiphysis


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