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

Abstract

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 (5.9+/-0.7 years).

Setting: Tertiary hospital.

Participants: Fifty-four women with TS (43.0+/-9.95 years). Interventions Hormone replacement therapy (HRT) and calcium and vitamin D supplementation. Main outcome measures BMD (g/cm(2)) 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 (0.601+/-0.059 vs 0.592+/-0.059, P=0.03), while spine BMD increased (0.972+/-0.139 vs 1.010+/-0.144, 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.