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Cited by 74Menopause: Health Impacts and TreatmentsGenetic and Clinical Aspects of Sex Determination and Chromosomal AbnormalitiesEstrogen and related hormone effects

Effect of estrogen replacement therapy on bone and cardiovascular outcomes in women with Turner syndrome: a systematic review and meta-analysis

Cintron, Dahima, Rodriguez-Gutierrez, Rene, Serrano, Valentina, Latortue-Albino, Paula, Erwin, Patricia J, Murad, Mohammad Hassan·2017·Endocrine
DOI 10.1007/s12020-016-1046-y
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Abstract

Patients with Turner syndrome have adverse bone and cardiovascular outcomes from chronic estrogen deficiency. Hence, long-term estrogen replacement therapy is the cornerstone treatment. The estimates of its effect and optimal use, however, remain uncertain. We aimed to summarize the benefits and harms of estrogen replacement therapy on bone, cardiovascular, vasomotor and quality of life outcomes in patients with Turner syndrome. A comprehensive search of four databases was performed from inception through January 2016. Randomized clinical trials and observational cohort studies studying the effect of estrogen replacement therapy in patients with Turner syndrome under the age of 40 were included. Independently and in duplicate reviewers selected studies, extracted data and assessed risk of bias. Subgroup analyses were based on route of administration and type of estrogen formulation. Twenty-five studies at moderate to high risk of bias (12 randomized trials, 13 cohort studies) with 771 patients were included. Using random-effects models, estrogen replacement therapy showed an increase in bone mineral density [weighted mean change from baseline 0.09 g/cm2 (0.04-0.14)] that differed by type of estrogen but not route of administration. Oral estrogen replacement therapy showed a higher increase in high density lipoprotein cholesterol levels when compared to transdermal [weighted mean difference 9.33 mg/dl (4.82-13.85)] with no significant effect on other lipid fractions. The current evidence suggests possible benefit of estrogen replacement therapy on bone mineral density and high density lipoprotein cholesterol. Whether this improvement translates into changes in patient important outcomes (cardiovascular events or fractures) remains uncertain. Larger randomized clinical trials with direct comparisons on patient important outcomes are necessary.

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63 of 63 references verified0 citation errors · 0 not checkable

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  • 17β-estradiol tends to lower blood pressure, improve liver function tests, and increase HDL cholesterol in women with Turner syndrome.

    “In addition, it tends to lower BP, improve liver function tests, and increase HDL cholesterol in women with TS.”

    From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [280]

  • A large recent review showed the effect of E2 was superior to ethinyl estradiol and conjugated equine estrogens for bone mineral density without difference according to route of administration.

    “A large recent review showed the effect of E2 was superior to ethinyl estradiol and conjugated equine estrogens for BMD without difference according to route of administration.”

    From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [280]

  • 17β-estradiol has been shown to be effective in maintaining and improving bone mineral density, increasing uterine size, and has some beneficial effects on endpoints relating to cardiovascular outcomes.

    “It has been shown to be effective in maintaining and improving BMD, increasing uterine size and has some beneficial effects on endpoints relating to cardiovascular outcomes.”

    From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [280]

  • Oral E2 gave rise to a greater increase in HDL cholesterol than transdermal E2, indicating a potential cardioprotective effect.

    “However, oral E2 gave rise to a greater increase in HDL cholesterol than TD E2 indicating a potential cardioprotective effect”

    From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [280]

  • Earlier initiation of HRT affects BMD with higher BMD/better bone quality/greater trabecular bone score.

    “Earlier initiation of HRT does affect BMD with higher BMD/better bone quality/greater trabecular bone score”

    From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [280]

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Authors
Cintron, D., Rodriguez-Gutierrez, R., Serrano, V., Latortue-Albino, P., Erwin, P. J., & Murad, M. H.
Affiliations
  • Mayo Clinic (US)
  • University of Puerto Rico, Medical Sciences Campus (PR)
Corresponding author
Murad, Mohammad Hassan
ORCID
Venue
Endocrine
Publisher
Springer Science and Business Media LLC
Published
2016-07-29
Volume
55
Issue
2
Pages
366-375
ISSN
  • 0969-711X (ISSN-L)
  • 1355-008X
  • 1559-0100
DOI
10.1007/s12020-016-1046-y
OpenAlex
W2487758358
Cited by
74
References
63
Citations by year
2026: 5 · 2025: 4 · 2024: 5 · 2023: 4 · 2022: 9 · 2021: 10 · 2020: 8 · 2019: 8 · 2018: 9 · 2017: 8 · 2016: 3
FWCI
1.37
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (unspecified)
Locations
  • Endocrine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic and Clinical Aspects of Sex Determination and Chromosomal Abnormalities
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Estrogen and related hormone effects
Keywords
Turner syndrome, estrogen replacement therapy, bone mineral density, cardiovascular outcomes, vasomotor symptoms, quality of life, estrogen deficiency, HDL cholesterol, transdermal estrogen, oral estrogen, fracture risk
MeSH terms
Cardiovascular Diseases, Estrogens, Female, Humans, Quality of Life, Turner Syndrome, Bone Density, Estrogen Replacement Therapy

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