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

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Abstract

Summary

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.

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Data availability

The datasets analyzed during this study are available from the corresponding author on reasonable request.

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Acknowledgments

This work was conducted independently without financial support from companies or funds. We wish to acknowledge Yokohama City University Medical Center and all Turner Syndrome patients who participated in the study. We wish to thank Assistant Professor Dr. Toshihiro Misumi from the Department of Biostatistics, Yokohama City University for providing appropriate advice in statistical analysis.

Funding

This work was conducted independently without financial support from companies or funds.

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Authors and Affiliations

  1. Department of Gynecology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan

    S. Saito, E. Koga, Y. Okada, T. Tsuburai, H. Yoshikata & H. Sakakibara

  2. Department of Obstetrics and Gynecology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan

    E. Miyagi

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  1. S. Saito
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  2. E. Koga
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  3. Y. Okada
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  4. T. Tsuburai
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  5. H. Yoshikata
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  7. H. Sakakibara
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Correspondence to H. Sakakibara.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approval for this study was obtained from the Ethics Committees of Yokohama City University School of Medicine (IRB number: B190300010).

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Informed consent for publication was obtained from all individual participants included in the study.

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Saito, S., Koga, E., Okada, Y. et al. Effects of age at estrogen replacement therapy initiation on trabecular bone score in Japanese adults with Turner syndrome. Osteoporos Int 32, 671–680 (2021). https://doi.org/10.1007/s00198-020-05652-1

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