A Longitudinal Study of the Effect of Subcutaneous Estrogen Replacement on Bone in Young Women With Turner's Syndrome

Abstract

It is desirable that young women with primary ovarian failure achieve normal peak bone mass to reduce the subsequent risk of osteoporosis, and that there are management strategies to replace bone that is already lost. While estrogen (E 2 ) is generally considered to prevent bone loss by suppressing bone resorption, it is now recognized that estrogen also exerts an anabolic effect on the human skeleton. In this study, we tested whether estrogen could increase bone mass in women with primary ovarian failure. We studied the mechanism underlying this by analyzing biochemical markers of bone turnover and iliac crest biopsy specimens obtained before and 3 years after E 2 replacement. Twenty-one women with Turner's syndrome, aged 20 -40 years, were studied. The T scores of bone mineral density at lumbar spine and proximal femur at baseline were ؊1.4 and -1.1, respectively. Hormone replacement was given as subcutaneous E 2 implants (50 mg every 6 months) with oral medroxy progesterone. Serum E 2 levels increased incrementally from 87.5 pM at baseline to 323, 506, 647, and 713 pM after 6 months and 1, 2, and 3 years of hormone replacement therapy (HRT), respectively. The bone mineral density at the lumbar spine and proximal femur increased after 3 years to T scores of -0.

Epidemiological, endocrine and metabolic features in Turner syndrome

“…There is a definite need for such studies to determine the ideal treatment regimen during adolescence for achieving two goals: (i) attaining maximal peak bone mass and maintaining BMD without compromising adult height, and (ii) with appropriate timing of pubertal induction to achieve appropriate secondary sex characteristics. Furthermore, the dosage of estrogen during adult life has to be determined, which has been highlighted by the recent paper by Khastgir et al (263). There are indications that the present dosage (i.e.…”

“…Recently, a 3-year longitudinal study of 21 women with TS (aged 20-40 years), with iliac crest biopsies before and 3 years after treatment with HRT showed compelling effects of estrogen on bone. The women were treated with estradiol implants (and oral gestagen cyclically) (263). The implants resulted in estradiol levels comparable to levels normally present in premenopausal women, and considerably higher than the levels achieved with the regimens (estradiol 2 mg orally or equivalent transdermal doses, i.e.…”

Gonadotropin Secretion in Girls with Turner Syndrome Measured by an Ultrasensitive Immunochemiluminometric Assay

“…In general, induction of puberty in TS has been delayed for several years to allow girls with TS to attain a higher stature [23]. Besides the psychosocial implications of late feminization, this practice may result in inadequate peak bone mass [24, 25], poor uterine development [26, 27] and an increased risk for CV disease [28,29,30]. Recent data suggest that low dose estrogen given by a percutaneous route may enhance growth and final adult stature [31, 32].…”

Epidemiological, endocrine and metabolic features in Turner syndrome

“…The women were treated with estradiol implants (and oral gestagen cyclically) (49). The implants resulted in estradiol levels comparable to levels normally present in premenopausal women, and considerably higher than the levels achieved with the regimens (estradiol 2mg orally or equivalent transdermal doses, i.e.…”