The utilization of recombinant human growth hormone therapy in pediatric populations, originally approved to treat diseases of growth hormone deficiency, has expanded to encompass a broader range of indications, leading to a threefold increase in its utilization in the last two decades. However, concerns regarding its safety, particularly those that are orthopedic in nature, have grown alongside its increasing popularity. Growth hormone usage has been reported to predispose patients to a multitude of common orthopedic conditions, including carpal tunnel syndrome, Legg–Calve–Perthes disease, little league shoulder, Osgood–Schlatter disease, osteochondritis dissecans, scoliosis, Sever’s disease, and slipped femoral capital epiphysis. The pathways by which growth hormone therapy can precipitate orthopedic pathology has been shown to be multifactorial, involving mechanisms such as hormonal changes, growth plate instability, rapid growth, and increased susceptibility to overuse injury. This review examines the orthopedic consequences of growth hormone therapy in pediatric patients by discussing these potential pathophysiologic mechanisms of injury and analyzing subsequent clinical manifestations. By examining processes underlying these complications, we highlight the need for orthopedic surveillance and management in children receiving GHT, particularly those with pre-existing musculoskeletal comorbidities or high levels of physical activity. Our findings underscore the importance of a multidisciplinary approach involving co-management by pediatricians, endocrinologists, and orthopedic surgeons to optimize safety and outcomes for these patients. Directions for future research include correlating pathophysiologic mechanisms to injury patterns, investigating long-term complications in recently approved growth hormone therapy indications, and informing clinical guidelines on the management of orthopedic injuries in this patient population.

Supplementary Table S6 summarizes missing screening outcome data within each cancer-specific eligible cohort, reporting participants without prior cancer, missing and nonmissing screening outcome counts, and the final complete-case sample sizes for breast, cervical, colorectal, and prostate cancer screening.

Supplementary Table S5 shows the stepwise derivation of the adult complete-case analytic cohort, including the number and percentage excluded at each stage and the remaining sample size after each exclusion criterion.

Supplementary Table S1A shows baseline characteristics of female cancer screening–eligible participants by food security status, reporting median age and unweighted counts with survey-weighted row percentages across high, marginal, and low/very low food security categories.