Osteoporosis and fractures in Turner syndrome–importance of growth promoting and oestrogen therapy

Landin‐Wilhelmsen, Kerstin; Bryman, Inger; Windh, Marianne; Wilhelmsen, Lars

doi:10.1046/j.1365-2265.1999.00841.x

Cited by 137 publications

(50 citation statements)

References 19 publications

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“…(11) Similarly, a clinical study reported an increased risk of fracture in TS individuals aged more than 45 years compared to a random population sample (odds ratio, 19.3; 95%CI, 4.1-88.6). (31) In accordance, we found lower finite element estimates of failure load in radius and tibia in TS patients compared to controls. Finite element estimates of bone strength are more closely related to bone strength compared to aBMD, as evidenced in a study using intact cadaver forearms.…”

Section: Discussionsupporting

confidence: 84%

“…Yet in a weight adjusted analysis, failure load remained lower in TS patients compared to controls in our study, suggesting a deficit in tibia bone strength relative to mechanical demands at this site also. While bone strength is of key importance for fracture risk, TS patients also have frequent deficits in hearing (13) and vision (31) that may increase the number of falls or accidents.…”

Section: Discussionmentioning

confidence: 99%

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Compromised trabecular microarchitecture and lower finite element estimates of radius and tibia bone strength in adults with turner syndrome: A cross-sectional study using high-resolution–pQCT

Hansen

Brixen

Gravholt

2012

Journal of Bone and Mineral Research

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Although bone mass appear ample for bone size in Turner syndrome (TS), epidemiological studies have reported an increased risk of fracture in TS. We used high-resolution peripheral quantitative computed tomography (HR-pQCT) to measure standard morphological parameters of bone geometry and microarchitecture, as well as estimated bone strength by finite element analysis (FEA) to assess bone characteristics beyond bone mineral density (BMD) that possibly contribute to the increased risk of fracture. Thirty-two TS patients (median age 35, range 20-61 years) and 32 healthy control subjects (median age 36, range 19-58 years) matched with the TS participants with respect to age and body-mass index were studied. A full region of interest (ROI) image analysis and a height-matched ROI analysis adjusting for differences in body height between groups were performed. Mean bone cross-sectional area was lower in TS patients in radius (À15%) and tibia (À13%) (both p < 0.01) whereas cortical thickness was higher in TS patients in radius (18%, p < 0.01) but not in tibia compared to controls. Cortical porosity was lower in TS patients at both sites (À32% in radius, À36% in tibia, both p < 0.0001). Trabecular integrity was compromised in TS patients with lower bone volume per tissue volume (BV/TV) (À27% in radius, À22% in tibia, both p < 0.0001), trabecular number (À27% in radius, À12% in tibia, both p < 0.05), and higher trabecular spacing (54% in radius, 23% in tibia, both p < 0.01). In the height-matched ROI analysis, differences remained significant apart from total area at both sites, cortical thickness in radius, and trabecular number in tibia. FEA estimated failure load was lower in TS patients in both radius (À11%) and tibia (À16%) (both p < 0.01) and remained significantly lower in the height-matched ROI analysis. Conclusively, TS patients had compromised trabecular microarchitecture and lower bone strength at both skeletal sites, which may partly account for the increased risk of fracture observed in these patients. ß

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Compromised trabecular microarchitecture and lower finite element estimates of radius and tibia bone strength in adults with turner syndrome: A cross-sectional study using high-resolution–pQCT

Hansen

Brixen

Gravholt

2012

Journal of Bone and Mineral Research

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“…Peak bone mass depends on several factors, such as genetic background, nutrition, physical activity, local growth factors, and a number of hormones (31,32). Evidently, many women with TS receive appropriate HRT late in life and for a shorter duration than is recommended (5,33,34). According to the WHO definition, more women with TS than controls were categorized as having osteoporosis and osteopenia.…”

Section: Discussionmentioning

confidence: 99%

“…Premature ovarian failure, if untreated, leaves patients deficient of female sex hormones from early childhood and onwards. Several studies have shown decreased bone mineral density (BMD) in girls as well as in younger and middle-aged women with TS (4)(5)(6)(7)(8). This finding may largely be due to the two-dimensional nature of dual energy x-ray absorptiometry (DEXA) scans (9), which fails to account for the reduced height in TS leading to lower BMD a priori.…”

Section: Introductionmentioning

confidence: 99%

Long-term hormone replacement therapy preserves bone mineral density in Turner syndrome

Cleemann

Hjerrild

Lauridsen

et al. 2009

European Journal of Endocrinology

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Context: Reduced bone mineral density (BMD) and increased risk of fractures are present in many women with Turner syndrome (TS). Objective: Examine longitudinal changes in BMD in TS and relate changes to biochemical parameters. Design: Prospective, pragmatic, and observational study. Examinations at baseline and follow-up (5.9G0.7 years). Setting: Tertiary hospital. Participants: Fifty-four women with TS (43.0G9.95 years). Interventions: Hormone replacement therapy (HRT) and calcium and vitamin D supplementation. Main outcome measures: BMD (g/cm2 ) measured at lumbar spine, hip, and the non-dominant forearm. Bone formation and resorption markers, sex hormones, IGF1, and maximal oxygen uptake. Results: At follow-up, forearm BMD, radius ultradistal BMD, and hip BMD remained unchanged, radius 1/3 BMD declined (0.601G0.059 vs 0.592G0.059, PZ0.03), while spine BMD increased (0.972G0.139 vs 1.010G0.144, P!0.0005). Bone formation markers did not change over time in TS. Bone resorption markers decreased over time in TS. Testosterone, IGF1, and maximal oxygen uptake was significantly reduced in TS. Conclusion: Longitudinal changes in BMD in TS were slight. BMD can be maintained at most sites in well-informed women with TS, being encouraged to maintain a healthy lifestyle, including HRT and intake of calcium and vitamin D.

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“…Several studies have shown decreased BMD in girls, as well as in younger and middle-aged women with TS (51,52). This finding may be largely due to the two--dimensional nature of dual energy x-ray absorptiometry (DEXA) scans (53), which fails to account for the reduced height in TS, leading to lower BMD a priori.…”

Section: Bone Mass Gain and Prevention Of Fractures In Turner Syndromementioning

confidence: 99%

Endocrine diseases, perspectives and care in Turner syndrome

Collett‐Solberg

Gallicchio

Coelho

et al. 2011

Arq Bras Endocrinol Metab

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SUMMARYTurner syndrome is a frequent chromosome disorder in clinical practice. It is characterized by short stature, gonadal dysgenesia and multisystemic involvement, responsible for a high morbidity and reduced life expectancy. The aim of the present paper is to describe the endocrinopathies and major problems at different ages, and to present suggestion for follow-up care in these patients. Arq Bras Endocrinol Metab. 2011;55(8):550-8

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Osteoporosis and fractures in Turner syndrome–importance of growth promoting and oestrogen therapy

Abstract: Osteoporosis and fractures were common above, but not below, 45 years of age in Turner syndrome. It is probable that modern therapy, including growth promoting and continuous oestrogen therapy, will prevent osteoporotic fractures in the future.

Cited by 137 publications

References 19 publications

Compromised trabecular microarchitecture and lower finite element estimates of radius and tibia bone strength in adults with turner syndrome: A cross-sectional study using high-resolution–pQCT

Compromised trabecular microarchitecture and lower finite element estimates of radius and tibia bone strength in adults with turner syndrome: A cross-sectional study using high-resolution–pQCT

Long-term hormone replacement therapy preserves bone mineral density in Turner syndrome

Endocrine diseases, perspectives and care in Turner syndrome

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