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


Nguyen, HH and Wong, P and Strauss, BJ and Jones, G and Ebeling, PR and Milat, F and Vincent, A, Delay in estrogen commencement is associated with lower bone mineral density in Turner syndrome, Climacteric, 20, (5) pp. 436-441. ISSN 1369-7137 (2017) [Refereed Article]

Copyright Statement

Copyright 2017 International Menopause Society

DOI: doi:10.1080/13697137.2017.1325461


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 < 0.01). More women with TS had spinal Z-score < -2.0 compared to controls (26.0% vs. 3.6%, 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 Details

Item Type:Refereed Article
Keywords:Turner syndrome, bone mineral density, estrogen, fracture, osteoporosis
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Rheumatology and arthritis
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Jones, G (Professor Graeme Jones)
ID Code:120429
Year Published:2017
Web of Science® Times Cited:22
Deposited By:Menzies Institute for Medical Research
Deposited On:2017-08-24
Last Modified:2018-06-21

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