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Delay in estrogen commencement is associated with lower bone mineral density in Turner syndrome

Nguyen, HH, Wong, P, Strauss, BJ, Jones, G ORCID: 0000-0002-9814-0006, Ebeling, PR, Milat, F and Vincent, A 2017 , 'Delay in estrogen commencement is associated with lower bone mineral density in Turner syndrome' , Climacteric, vol. 20, no. 5 , pp. 436-441 , doi: 10.1080/13697137.2017.1325461.

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Abstract

Objective: Turner syndrome (TS) is associated with hypogonadism, osteoporosis and fractures. We investigated the prevalence and risk factors for low bone density and fractures in a TS cohort.Methods: We included 76 TS patients (median age 28.5 years) attending a tertiary hospital between 1998 and 2015 who underwent dual-energy X-ray absorptiometry. Spine and femoral neck (FN) areal bone mineral density (aBMD) were compared with those of a control group. To adjust for smaller bone size, bone mineral apparent density (BMAD) was calculated.Results: Primary amenorrhea was common (83%) in the TS cohort; the median age of pubertal induction was 15 years (range 11-30 years), and non-continuous estrogen therapy (ET) recorded in 40%. Almost one-third of TS patients reported fractures. TS patients had lower median spinal aBMD (1.026 g/cm2 vs. 1.221 g/cm2) and BMAD (0.156 g/cm3 vs. 0.161 g/cm3) than controls, and lower median FN aBMD (0.850 g/cm2 vs. 1.026 g/cm2) (all p p = 0.001). Spine and FN aBMD, BMAD and Z-scores were inversely associated with age commencing ET or years of estrogen deficiency.Conclusions: Delay in ET commencement was an independent risk factor for the lower bone density observed in women with TS. Early pubertal induction and ET compliance are important targets to optimize aBMD.

Item Type: Article
Authors/Creators:Nguyen, HH and Wong, P and Strauss, BJ and Jones, G and Ebeling, PR and Milat, F and Vincent, A
Keywords: Turner syndrome, bone mineral density, estrogen, fracture, osteoporosis
Journal or Publication Title: Climacteric
Publisher: Parthenon Publishing Group
ISSN: 1369-7137
DOI / ID Number: 10.1080/13697137.2017.1325461
Copyright Information:

Copyright 2017 International Menopause Society

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