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J Clin Endocrinol Metab 2018, 103(3):, 2018; 103(3): 1188–1197, PMID: 29300907

A 6-Year Follow-Up of Fracture Incidence and Volumetric Bone Mineral Density Development in Girls with Turner Syndrome.

Year: 2018

Soucek O, Schonau E, Lebl J, Willnecker J, Hlavka Z, Sumnik Z
Department of Pediatrics, Second Medical Faculty, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.


Context: Patients with Turner Syndrome (TS) are at risk of osteoporotic fractures. Objective: The aims of this study were to assess the incidence of clinically significant fractures in girls with TS and prospectively describe the development of volumetric bone mineral density (BMD). Design: Peripheral quantitative computerized tomography (pQCT) of the radius every other year over the 6 years of observation. Setting: Government funded university referral center. Participants: Thirty two girls with TS aged 6-16 years were included in the analyses. Bone density and strength was compared to data from 185 healthy girls. Fracture incidence was compared to the data in the general population. Outcomes: The main clinical outcome was the fracture occurrence. The secondary outcomes were the changes in Z-scores of the bone parameters. Results: Three girls with TS sustained four fractures during 6-years of observation. The fracture rate in TS was not significantly higher than the downward-biased fracture rate estimate in age-matched healthy controls (p=0.48). Whereas trabecular BMD Z-score decreased with age (estimate -0.21+/-0.04, p<0.001), total bone cross-sectional area correspondingly increased (+0.16+/-0.04, p<0.001), which lead to normal bone strength. A positive history of incident fractures was not significantly associated with any of the pQCT-derived bone parameters. Conclusions: Current pediatric TS patients that are treated with growth hormone and estrogens are not at risk of osteoporotic fractures. Low BMD in TS may be counterweighted by enlarged bone radius, which leads to normal bone strength at the appendicular skeleton.

GID: 4571; Last update: 08.01.2018