Abstract
A longitudinal observational study was performed comparing BMD and body composition in Turner syndrome girls before and after 1 year of HRT treatment. Whole body BMD, femur neck BMD, total hip BMD, and lean mass were significantly increased, but there was no difference in fat mass, and lumbar spine BMD.Purpose: Low bone mineral density (BMD) is one of the major health problems in Turner syndrome (TS) patients, and a certain percentage of TS girls are treated with hormone replacement therapy (HRT) to improve their BMD, among other health benefits. While it is generally accepted that HRT improves BMD and body composition in adolescent and young adult TS patients, studies of HRT in Chinese TS patients are limited.Methods: To investigate the effects of HRT in Chinese TS girls, we performed a longitudinal observational study which compared measurement of BMD and body composition by dual energy X-ray absorptiometry (DXA) using a Lunar DXA densitometer in 20 Chinese adolescent and young adult TS patients (average age = 18) before and after 1 year of HRT treatment.Results: Whole body BMD (0.85 vs. 0.87 g/cm2, P < 0.001), femur neck BMD (0.6 vs. 0.62 g/cm2, P = 0.02), total hip BMD (0.68 vs. 0.71 g/cm2, P = 0.003) and whole body lean mass (30.39 vs. 31.66 kg, P = 0.002) were significantly increased in these patients after 1 year HRT treatment, but there was no difference in whole body fat mass, android:gynoid ratio and lumbar spine BMD.Conclusions: In summary, our study found that HRT was an effective way to increase whole body BMD, femur neck BMD, total hip BMD and whole body lean mass in Chinese TS girls, with no effect on whole body fat mass, android:gynoid ratio or lumbar spine BMD.
Highlights
Turner syndrome (TS), a disease caused by the deletion or structural abnormality of one X chromosome, is characterized by short stature, low hormone, and congenital under development of the uterus and ovaries [1]
There was a significant difference in whole body bone mineral density (BMD) (P < 0.0001), whole body Bone mineral content (BMC) (Bone Mineral Content, P < 0.0001), whole body bone area (P = 0.003), femur neck BMD (P = 0.01), total hip BMD (P = 0.002), total hip BMC (P = 0.05), whole body lean mass (P = 0.004), and whole body mass (P = 0.005) (Table 2)
After 12 months Hormone replacement therapy (HRT) treatment, whole body BMD (P < 0.001), whole body BMC (P < 0.001), whole body bone area (P < 0.001), femur neck BMD (P = 0.02), total hip BMD (P = 0.003), total hip BMC (P = 0.04), whole body lean mass (P = 0.002), and whole body mass (P = 0.007) were significantly increased, and there was no significant difference found in lumbar spine BMD, lumbar spine BMC, lumbar spine bone area, femur neck bone area and total hip bone area (Table 3; Figures 1, 2)
Summary
Turner syndrome (TS), a disease caused by the deletion or structural abnormality of one X chromosome, is characterized by short stature, low hormone, and congenital under development of the uterus and ovaries [1]. The symptoms of TS are varied, but all TS patients report a higher frequency of medical conditions compared to the normal population [3]. TS women have a higher frequency of osteopenia/osteoporosis and bone fracture than normal females [5]. The reasons for low BMD and increased bone fragility are multifarious, including chronic hormone deficiency (especially estrogen deficiency), X-chromosome abnormalities (especially haploinsufficiency of the SHOX gene), and other environmental factors (such as few/decreased physical activity due to skeletal muscular dysplasia) [2, 4, 6]
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