The Link Between Growth Hormone Therapy and Fracture Risk in Children

The research identified an increased risk for fractures at the top of the shinbone in patients who are still growing and taking growth hormone. Children with growth plate fractures of the upper shinbone (tibia) were 15 times more likely to have received human growth hormone therapy compared with a comparison group of children that had more typical midshaft tibia fractures.

Surgeons at HSS had seen an increasing number of tibia growth plate fractures in their practices in recent years. Parents were curious if the human growth hormone therapy their children were taking could be predisposing their children to these fractures. These concerns helped spur the investigation into the relationship between injury and therapy in pediatric patients. 

This study, published in a 2023 issue of Journal of Bone and Joint Surgery, was the first to put concrete numbers to this concerning link, says Daniel W. Green, MD, MS, FACS, Chief of Pediatric Orthopedic Surgery at HSS. “Most pediatricians and endocrinologists are unaware of these recent findings and may not be counseling patients and parents about this association,” he adds. 

“We now know there is a link between these types of fractures and growth hormone therapy, so it should be considered as part of the overall risk profile between patient and endocrinologist,” says Peter D. Fabricant, MD, a pediatric orthopedic surgeon at HSS and senior author of the research.

Here’s what you need to know about the link between growth hormone therapy and tibia growth plate fractures in children.

When is growth hormone treatment typically prescribed in children?

Growth hormone therapy can be recommended for several conditions, including:
•    Growth hormone deficiency (GHD)
•    Idiopathic short stature
•    Turner syndrome (TS)
•    Small for gestational age (SGA)
•    Prader-Willi syndrome (PWS)
•    Chronic renal insufficiency (CRI)
Growth hormone therapy is typically prescribed by an endocrinologist. When considering the treatment for your child, it’s important to discuss all the risks and benefits of the treatment.

What does a growth plate fracture mean for your child?

A growth plate fracture is a break in the growth plate. This area of the bone, also known as the physis, is a disc (or plate) of cartilage located near the ends of a child's long bones, such as those in the arms and legs. It is crucial for a child's growth because it is where new bone tissue is formed, allowing the bones to lengthen.

The growth plate is particularly vulnerable to damage because it is softer than other parts of the bone, making it a potentially weaker point and more prone to injury or fracture, says Dr. Fabricant.

Early symptoms of a growth plate problem that could indicate it’s weaker or softer than it should be may include pain in that area with activities and/or tenderness over the bone, Dr. Fabricant says. If your child brings one of these issues up, it could be an early warning sign to address with their physician to possibly avoid a fracture down the line.

Tibia growth plate fractures tend to be rare, but they are serious injuries. That means they could require surgery, are usually urgent issues, the bone may take up to three months to fully heal, and it could take six to 12 months for the body to be strong enough to return to sports. Though they make up a small percentage of pediatric fractures, over 40 percent of pediatric patients with these injuries require surgery, Dr. Fabricant says.

How does growth hormone treatment increase fracture risk?

Growth hormone influences bone growth in several ways that may weaken the growth plate and increase fracture risk.

Growth hormone mainly acts on certain areas of the growth plate, making the cartilage cells (called chondrocytes) grow and multiply. This stimulates long bone growth and remodeling. These changes   can also make the growth plate softer and weaker, however, especially in the top part of the shinbone. Because of this, the bone can be more likely to break or get pulled apart when the muscles pull very hard, most likely to occur during forceful jumping or a hard landing.  

“This is [more likely] in the lower extremities where forces on the legs are higher,” says Dr. Fabricant. “For example, in the injuries we studied, the quadriceps muscle pulls on the patellar tendon, which pulls off a piece of the top of the shinbone.”

If you’re reading this and are concerned about an older child who was on growth hormone therapy in early years, talk to their endocrinologist about your concerns. Regularly check in with your child about any pains they’re experiencing while playing sports, as these are signs to pay attention to and bring up with a healthcare provider before they turn into a serious issue.

The new research on growth hormone risk

Parents should talk with the pediatric endocrinologist if they have concerns about growth hormone therapy   and ask if the benefits outweigh the risks. As it relates to this study, caregivers and parents should ask about fracture risk while on the growth hormone and perhaps share this study with their endocrinologist, suggests Dr. Fabricant. Parents could also ask if the child’s underlying condition — like chronic renal insufficiency — presents any fracture risks.  

Work with the child’s healthcare team to decide if growth hormone treatment is a good idea for the child. It is important to think about both the benefits of treatment and the possible risks, like broken bones, especially for kids who are very active.

Published 10/28/2025

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