Effects of age at estrogen replacement therapy initiation on trabecular bone score in Japanese adults with Turner syndrome

S Saito; E Koga; Y Okada; T Tsuburai; H Yoshikata; E Miyagi; H Sakakibara

doi:10.1007/s00198-020-05652-1

Effects of age at estrogen replacement therapy initiation on trabecular bone score in Japanese adults with Turner syndrome

Osteoporos Int. 2021 Apr;32(4):671-680. doi: 10.1007/s00198-020-05652-1. Epub 2020 Sep 23.

Authors

S Saito¹, E Koga¹, Y Okada¹, T Tsuburai¹, H Yoshikata¹, E Miyagi², H Sakakibara³

Affiliations

¹ Department of Gynecology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
² Department of Obstetrics and Gynecology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
³ Department of Gynecology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan. sakakih@yokohama-cu.ac.jp.

PMID: 32968889
DOI: 10.1007/s00198-020-05652-1

Abstract

The effects of the age at estrogen replacement therapy (ERT) initiation on bone quality in Turner syndrome were evaluated using trabecular bone score. Early puberty ERT positively correlated with increase in bone quality. Early initiation of ERT is necessary for the acquisition of bone quality as well as bone density.

Introduction: Studies have reported associations between bone mineral density and estrogen replacement therapy (ERT) in Turner syndrome (TS) patients; however, few studies exist on the effect on bone quality. The aim of this study was to evaluate the effects of the age at ERT initiation on bone quality of Japanese TS patients, cross-sectionally and longitudinally.

Methods: Cross-sectionally, 95 TS patients were divided into three groups based on their age at initiation of ERT: A (12-14 years, 11 patients), B (15-17 years, 47 patients), and C (over 18 years, 37 patients). To assess bone quality, trabecular bone score (TBS) was used. The effects of age at initiation and duration of ERT on TBS were examined using multiple regression analysis. In the longitudinal study, 48 patients who underwent dual-energy X-ray absorptiometry multiple times were divided into three groups: D (12-14 years, 8 patients), E (15-17 years, 18 patients), and F (over 18 years, 22 patients). Each group was analyzed for the rate of change in TBS per year.

Results: Cross-sectionally, the TBS showed significant differences among the three groups (TBS A, 1.302; B, 1.299; C, 1.245) (p = 0.013); group C was significantly lower than B (p = 0.014); bone quality was degraded. Multiple regression analysis revealed that age at ERT initiation significantly affected the increase in TBS (p = 0.002). Longitudinally, the rate of change of TBS was not significantly different in the three groups (p = 0.73).

Conclusion: Early initiation of ERT may have positive effects on bone quality in TS. Large prospective studies will be needed.

Keywords: Bone quality; Dual-energy X-ray absorptiometry; Estrogen replacement therapy; Fracture; Trabecular bone score; Turner syndrome.

MeSH terms

Absorptiometry, Photon
Adult
Bone Density
Cancellous Bone* / diagnostic imaging
Estrogen Replacement Therapy
Female
Humans
Japan
Longitudinal Studies
Lumbar Vertebrae
Prospective Studies
Turner Syndrome* / drug therapy