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

Abstract

ContextReduced bone mineral density (BMD) and increased risk of fractures are present in many women with Turner syndrome (TS).ObjectiveExamine longitudinal changes in BMD in TS and relate changes to biochemical parameters.DesignProspective, pragmatic, and observational study. Examinations at baseline and follow-up (5.9±0.7 years).SettingTertiary hospital.ParticipantsFifty-four women with TS (43.0±9.95 years).InterventionsHormone replacement therapy (HRT) and calcium and vitamin D supplementation.Main outcome measuresBMD (g/cm2) measured at lumbar spine, hip, and the non-dominant forearm. Bone formation and resorption markers, sex hormones, IGF1, and maximal oxygen uptake.ResultsAt 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.ConclusionLongitudinal 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.