Reduced cortical bone density with normal trabecular bone density in girls with Turner syndrome

Holroyd, Christopher; Davies, Justin H; Taylor, P; Jameson, Karen; Rivett, C.; Cooper, Cyrus; Dennison, Elaine

doi:10.1007/s00198-010-1170-0

Cited by 52 publications

(51 citation statements)

References 25 publications

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“…This hypothesis owes to studies reporting lower aBMD of the one-third distal radius opposed to the ultradistal radius using DXA, (8,35) and lower cortical vBMD and/or cortical thickness in the proximal radius using pQCT. (18)(19)(20) Our results do not support the hypothesis of a selective cortical bone deficit in TS. On the contrary, TS patients in our study had compromised trabecular integrity in both radius and tibia, with significantly lower trabecular BV/TV and higher trabecular spacing.…”

Section: Discussioncontrasting

confidence: 99%

“…(38) Correspondingly, Soucek and colleagues (20) reported that when proximal radius cortical vBMD in TS patients was adjusted for partial volume artifacts, cortical vBMD rose from below normal to above normal reference values. Third, TS patients in our study were older (median age 35 years) compared to previous studies using pQCT (age range 6-25 years (18)(19)(20) ). Finally, participants in all studies had received varying amounts of GH and androgen therapy, which have both been shown to affect bone health.…”

Section: Discussionmentioning

confidence: 66%

“…However, no evidence of cortical bone deficits in TS patients was found in our study. Also, differences in HR-pQCT and pQCT methodologies may be of importance, as cortical thickness in the HR-pQCT methodology applied here was a 3D measure of the periosteal-endosteal distance, (26) whereas cortical thickness in pQCT studies (18,19) was derived mathematically, assuming that the radius crosssection is circularly shaped (37) ; an assumption that may be challenged, perhaps especially in TS individuals. Also, measurement of cortical vBMD by pQCT is influenced by cortical thickness, due to partial volume artifacts, resulting in falsely low values in thin compared to thicker cortices.…”

Section: Discussionmentioning

confidence: 99%

“…All used peripheral quantitative computed tomography (pQCT) to study compartmental geometry and density in radius. Two studies reported deficits in cortical bone in adolescents (18) and young adults, (19) whereas both cortical and trabecular bone deficits in young adult TS patients was found in one study. (20) With the latest generation of highresolution pQCT (HR-pQCT), image resolution has been markedly refined, which permits detailed bone microarchitecture evaluation.…”

Section: Introductionmentioning

confidence: 93%

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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: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

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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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“…Some authors observed reduced BMD at the femoral neck; QCT data suggests that cortical density is reduced with sparing of trabecular bone. This differential of cortical and trabecular BMD may predispose to fracture (56). There is an approximately 25% increase in fracture risk, most of which is related to medium or high-impact trauma.…”

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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Fracture Management in the Infant, Child and Young Person

Wright

2014

Orthopaedic and Trauma Nursing

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Reduced cortical bone density with normal trabecular bone density in girls with Turner syndrome

Abstract: TS is associated with reduced BMAD at the femoral neck; pQCT data suggests that cortical density is reduced with sparing of trabecular bone. This differential of cortical and trabecular BMD may predispose to fracture.

Cited by 52 publications

References 25 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

Endocrine diseases, perspectives and care in Turner syndrome

Fracture Management in the Infant, Child and Young Person

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