Starting age of oestrogen-progestin therapy is negatively associated with bone mineral density in young adults with Turner syndrome independent of age and body mass index
Abstract
OBJECTIVE: Osteoporosis is an important health issue in patients with Turner syndrome (TS), and oestrogen sufficiency has been implicated in increased bone mineral density (BMD); however, the impact of the starting age of hormone replacement therapy (HRT) on bone mineral density 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 bone mineral density (L-BMD), including areal BMD (aBMD) and volumetric BMD (vBMD), karyotypes, the presence of spontaneous menarche, the starting ages of oestrogen replacement therapy (ERT) and oestrogen-progestin therapy (EPT), and the duration between starting ages of oestrogen replacement therapy and oestrogen-progestin therapy 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 oestrogen replacement therapy was used in 84% of subjects without spontaneous menarche (N = 81). The starting age of oestrogen replacement therapy and the duration between the starting ages of oestrogen replacement therapy and oestrogen-progestin therapy negatively and independently correlated with aBMD, but not with vBMD, after adjustment with age and BMI. The starting age of oestrogen-progestin therapy negatively correlated with L-BMD independent of age and BMI. CONCLUSIONS: Early introduction of hormone replacement therapy, particularly oestrogen-progestin therapy, is important to accrue better L-BMD in young adults with TS.
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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 [352]
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Clinical practice guidelines for the care of girls and women with Turner syndrome.
Gravholt, C. H., Andersen, N. H., Christin-Maitre, S., Davis, S. M., Duijnhouwer, A., Gawlik, A., Maciel-Guerra, A. T., Gutmark-Little, I., Fleischer, K., Hong, D., et al. (2024) · European Journal of Endocrinology · doi:10.1093/ejendo/lvae050 · Cited by 224 · see citing works
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Gravholt, C. H., Viuff, M., Just, J., Sandahl, K., Brun, S., van der Velden, J., Andersen, N. H., & Skakkebaek, A. (2023) · Endocrine Reviews · doi:10.1210/endrev/bnac016 · Cited by 149 · see citing works
- Authors
- Nishigaki, S., Itonaga, T., Hasegawa, Y., & Kawai, M.
- Affiliations
- Osaka City University (JP)
- Tokyo Metropolitan Children's Medical Center (JP)
- Osaka Women's and Children's Hospital (JP)
- Corresponding author
- Kawai, Masanobu
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2021-05-03
- Volume
- 95
- Issue
- 1
- Pages
- 84-91
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W3156353821
- Cited by
- 19
- References
- 27
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 6 · 2023: 3 · 2022: 4 · 2021: 1
- FWCI
- 3.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic and Clinical Aspects of Sex Determination and Chromosomal Abnormalities
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Keywords
- Turner syndrome, estrogen replacement therapy, bone mineral density, lumbar spine bone mineral density, young adults, osteoporosis, body mass index, volumetric bone mineral density, dose escalation
- MeSH terms
- Adolescent, Adult, Estrogens, Female, Humans, Progestins, Retrospective Studies, Turner Syndrome, Absorptiometry, Photon, Bone Density, Estrogen Replacement Therapy, Body Mass Index, Young Adult
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