Lack of an acute effect of ghrelin on markers of bone turnover in healthy controls and post-gastrectomy subjects

Background Ghrelin is a gut-brain peptide that powerfully stimulates appetite and growth hormone secretion and is also known to directly regulate osteoblast cell function in vitro and in animal models. Little is known about the effects of ghrelin on bone turnover in humans. As the stomach is the main site of ghrelin synthesis, gastrectomy patients are deficient in ghrelin; they are also prone to osteopenia and osteomalacia. Hypothesis Ghrelin may play a role in bone regulation in humans; ghrelin deficiency following gastrectomy is associated with the disrupted regulation of bone turnover seen in these subjects. Subjects and methods In a randomised, double-blind, placebo-controlled study 8 healthy controls and 8 post-gastrectomy subjects were infused with intravenous ghrelin (5 pmol/kg/min) or saline over 240 min on different days. Subjects were given a fixed energy meal during the infusion. Ghrelin, GH, type-1 collagen β C-telopeptide (βCTX), a marker of bone resorption, and procollagen type-1 amino-terminal propeptide (P1NP), a marker of bone formation, were measured. Results Fasting ghrelin was significantly lower in the gastrectomy group during the saline infusion (226.1 ± 62.0 vs. 762 ± 71.1 ng/l p < 0.001). Growth hormone was significantly higher at 90 min after the ghrelin infusion, compared to saline in both healthy controls (61.1 ± 8.8 vs. 1.4 ± 0.6 mIU/l p < 0.001) and gastrectomy subjects (61.1 ± 11.8 vs. 0.9 ± 0.2 mIU/l p < 0.001) confirming the ghrelin was bioactive. Gastrectomy subjects were significantly older and had significantly higher plasma βCTX than healthy controls at all time points (ANOVA p = 0.009). After adjustment for age and BMI ghrelin was found to be a significant predictor of baseline plasma βCTX and was inversely correlated with baseline plasma βCTX (β = − 0.54 p = 0.03 R2 = 26%). However, there was no significant effect of the ghrelin infusion on plasma βCTX or P1NP in either subject group. Conclusions Ghrelin infusion has no acute effect on markers of bone turnover in healthy controls and post-gastrectomy subjects, but is inversely correlated with bone resorption.