Satsuki Nishigaki1, Tomoyo Itonaga2, Yukihiro Hasegawa2, Masanobu Kawai3,4. 1. Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan. 2. Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan. 3. Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Japan. 4. Department of Bone and Mineral Research, Research Institute, Osaka Women's and Children's Hospital, Izumi, Japan.
Abstract
OBJECTIVE: Osteoporosis is an important health issue in patients with Turner syndrome (TS), and oestrogen sufficiency has been implicated in increased bone mineral density (BMD); however, the impact of the starting age of hormone replacement therapy (HRT) on bone mineral density remains unclear, particularly during young adulthood. DESIGN: A retrospective study from three tertiary care hospitals in Japan. PATIENTS: One hundred and three patients with TS aged between 18 and 30 years of age who underwent dual-energy X-ray absorptiometry. MEASUREMENTS: Anthropometric parameters, lumbar bone mineral density (L-BMD), including areal BMD (aBMD) and volumetric BMD (vBMD), karyotypes, the presence of spontaneous menarche, the starting ages of oestrogen replacement therapy (ERT) and oestrogen-progestin therapy (EPT), and the duration between starting ages of oestrogen replacement therapy and oestrogen-progestin therapy were investigated. vBMD was calculated based on the Kröger method. RESULTS: aBMD was lower in young adults with TS than in an age-matched reference population. L-BMD positively correlated with weight and body mass index (BMI). L-BMD was higher in subjects with spontaneous menarche (N = 22) than in those without. A dose escalation regimen of oestrogen replacement therapy was used in 84% of subjects without spontaneous menarche (N = 81). The starting age of oestrogen replacement therapy and the duration between the starting ages of oestrogen replacement therapy and oestrogen-progestin therapy negatively and independently correlated with aBMD, but not with vBMD, after adjustment with age and BMI. The starting age of oestrogen-progestin therapy negatively correlated with L-BMD independent of age and BMI. CONCLUSIONS: Early introduction of hormone replacement therapy, particularly oestrogen-progestin therapy, is important to accrue better L-BMD in young adults with TS.
OBJECTIVE: Osteoporosis is an important health issue in patients with Turner syndrome (TS), and oestrogen sufficiency has been implicated in increased bone mineral density (BMD); however, the impact of the starting age of hormone replacement therapy (HRT) on bone mineral density remains unclear, particularly during young adulthood. DESIGN: A retrospective study from three tertiary care hospitals in Japan. PATIENTS: One hundred and three patients with TS aged between 18 and 30 years of age who underwent dual-energy X-ray absorptiometry. MEASUREMENTS: Anthropometric parameters, lumbar bone mineral density (L-BMD), including areal BMD (aBMD) and volumetric BMD (vBMD), karyotypes, the presence of spontaneous menarche, the starting ages of oestrogen replacement therapy (ERT) and oestrogen-progestin therapy (EPT), and the duration between starting ages of oestrogen replacement therapy and oestrogen-progestin therapy were investigated. vBMD was calculated based on the Kröger method. RESULTS: aBMD was lower in young adults with TS than in an age-matched reference population. L-BMD positively correlated with weight and body mass index (BMI). L-BMD was higher in subjects with spontaneous menarche (N = 22) than in those without. A dose escalation regimen of oestrogen replacement therapy was used in 84% of subjects without spontaneous menarche (N = 81). The starting age of oestrogen replacement therapy and the duration between the starting ages of oestrogen replacement therapy and oestrogen-progestin therapy negatively and independently correlated with aBMD, but not with vBMD, after adjustment with age and BMI. The starting age of oestrogen-progestin therapy negatively correlated with L-BMD independent of age and BMI. CONCLUSIONS: Early introduction of hormone replacement therapy, particularly oestrogen-progestin therapy, is important to accrue better L-BMD in young adults with TS.
Authors: M Chiarito; L Piacente; N Chaoul; P Pontrelli; G D'Amato; A Grandone; G Russo; M E Street; M G Wasniewska; G Brunetti; M F Faienza Journal: J Endocrinol Invest Date: 2022-03-02 Impact factor: 5.467