- Anabolic steroids and human growth hormone help people build muscle.
- Could these drugs benefit some of your older hip and knee arthroplasty patients?
- The drugs carry some risks of heart and bone disease.
- Do these risks outweigh the risk of weakness and immobility?
A-Rod, as Alex Rodriguez is known, is off to a hot start this year and hitting plenty of home runs. Mr. Rodriguez has been convicted of using performance-enhancing drugs. Like Lance Armstrong, Ben Johnson, Marion Jones, Sammy Sosa, Mark McGuire, and countless other athletes, they took performance-enhancing drugs (PEDs) in order to enhance their performance. And the drugs worked. (See Figures.)
Strong young athletes with natural ability do not need drugs to achieve great performance. Your older patients, however, those who’ve had hips or knees replaced – or those who have severely physically deconditioned simply because it had been too painful to move or exercise – could use a little performance enhancement.
Of course there are risks, especially to younger men and women, of taking anabolic steroids or human growth hormone. But are those truly significant clinical risks in an older patient?
Ask yourself: Of these two factors, which poses a greater risk to your patient: a) immobility due to pain or weakness; or, b) a course of a performance-enhancing drug such as an anabolic steroid or human growth hormone?
According to a set of recent research studies and a systematic review, your older hip and knee arthroplasty patients might in fact benefit significantly from a PED.
Australian researchers conducted a doubled blind, prospective study (http://www.josr-online.com/content/5/1/93) of the use of anabolic steroids in patients who were undergoing total knee arthroplasty. The researchers reported promising results in 10 patients.
Patients receiving steroids generally performed better than the placebo group on all of the functional tests. Levels of quadriceps muscle strength across the postoperative period reached statistical significance at 3, 6, and 12 months. There was a significant difference for the Knee Society score (KSS) at 6 weeks, 6, and 12 month.
According to a recent systematic meta-analysis by the Cochrane collaboration, “the available data points to the potential for more promising outcomes with a combined anabolic steroid and nutritional supplement intervention.”
The Cochrane reviewers looked at 3 randomized controlled trials that involved 154 female participants aged 65 years or older. While the results of the meta-analysis were mixed, there was evidence of higher quality of life in the groups that took steroids plus nutrition supplementation.
Certainly testosterone replacement therapy should be considered in any older man who is deficient in endogenous testosterone.
Human Growth Hormone
An recent article in the Harvard Health Publications of the Harvard Medical School, argues that “Adults with bona fide GH [growth hormone] deficiencies benefit from GH injections. They enjoy protection from fractures, increased muscle mass, improved exercise capacity and energy, and a reduced risk of future heart disease. But there is a price to pay. Up to 30% of patients experience side effects that include fluid retention, joint and muscle pain, carpal tunnel syndrome (pressure on the nerve in the wrist causing hand pain and numbness), and high blood sugar levels.”
In other words, adults who are deficient in HGH can develop larger muscles, have more energy, and improved exercise capacity from if they receive replacement therapy. This seems like a good thing all around for older people.
Talk to your patients about this quality-of-life treatment. Consider the differences that HGH or anabolic steroids could make in the life of a 75-year-old or an 80-year-old who is frail but exercises. She or he will build muscle and become exercise tolerant much more quickly than the patient who is not taking a PED.
Would the side effects of HGH or anabolic steroids injure this patient or reduce her quality of life as quickly as would her frailty?