To the Editor.
—The article by Rico et al, in the Archives (139:1263-1265, 1979), suggests that deficient growth hormone response to a variety of stimuli may be relevant to the pathogenesis of postmenopausal osteoporosis. However, there is an alternate explanation for the deficient growth hormone response in osteoporotic patients. Patients with osteoporosis may have lower levels of estrone1 and estradiol2 than age-matched nonosteoporotic patients. It is well known that the growth hormone response to provocative stimuli is blunted in hypoestrogenemic states.3 Therefore, the abnormal growth hormone responses seen in the osteoporotic patients of Rico and co-workers may correlate with their endogenous estrogen levels. Although deficient growth hormone may be etiologically relevant to postmenopausal osteoporosis, it may simply be a marker of deficient estrogen status.