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Starting age of estrogen-progestin therapy is negatively associated with bone mineral density in young adults with Turner Syndrome independent of age and body mass index

Satsuki Nishigaki 1Tomoyo Itonaga 2Yukihiro Hasegawa 2Masanobu Kawai 3 4

Clin Endocrinol (Oxf). 2021 Apr 19.doi: 10.1111/cen.14484. 


Objective: Osteoporosis is an important health issue in patients with Turner syndrome (TS) and estrogen sufficiency has been implicated in increased bone mineral density (BMD); however, the impact of the starting age of hormone replacement therapy (HRT) on BMD 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 BMD (L-BMD) including areal BMD (aBMD) and volumetric BMD (vBMD), karyotypes, the presence of spontaneous menarche, the starting ages of estrogen replacement therapy (ERT) and estrogen-progestin therapy (EPT), and the duration between starting ages of ERT and EPT 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 ERT was used in 84% of subjects without spontaneous menarche (N=81). The starting age of ERT and the duration between the starting ages of ERT and EPT negatively and independently correlated with aBMD, but not with vBMD, after adjustment with age and BMI. The starting age of EPT negatively correlated with L-BMD independent of age and BMI.

Conclusions: Early introduction of HRT, particularly EPT, is important to accrue better L-BMD in young adults with TS.