J Korean Med Sci.  2024 Jan;39(1):e9. 10.3346/jkms.2024.39.e9.

Effects of Hormone Replacement Therapy on Bone Mineral Density in Korean Adults With Turner Syndrome

• Kim S
• Kim H
• Lee I
• Choi E
• Baek J
• Lee J
• Kim HR
• Yun BH
• Choi YS
• Seo SK

• KMID: 2550796
• DOI: http://doi.org/10.3346/jkms.2024.39.e9

Abstract

Background
Turner syndrome (TS) is a common chromosomal abnormality, which is caused by loss of all or part of one X chromosome. Hormone replacement therapy in TS is important in terms of puberty, growth and prevention of osteoporosis however, such a study has never been conducted in Korea. Therefore, the purpose of our study was to determine relationship between the starting age, duration of estrogen replacement therapy (ERT) in TS and develop a hormone replacement protocol suitable for the situation in Korea.
Methods
This is retrospective study analyzed the medical records in TS patients treated at the Severance hospital, Yonsei University College of Medicine, Seoul, Korea from 1997 to 2019. Total of 188 subjects who had received a bone density test at least once were included in the study. Korean National Health and Nutrition Examination Survey (KNHANES) was used for achieving bone mineral density (BMD) of normal control group. Student’s t-test, MannWhitney U test, ANOVA and correlation analysis were performed using SPSS 18.0.
Results
Each BMD measurement was significantly lower in women with TS than in healthy Korean women. Early start and longer duration of ERT is associated with higher lumbar spine BMD but not femur neck BMD. Femur neck BMD, but not lumbar spine BMD was significantly higher in women with mosaicism than 45XO group.
Conclusion
Early onset and appropriate duration of hormone replacement therapy is important for increasing bone mineral density in patients with Turner syndrome. Also, ERT affects differently to TS patients according to mosaicism.

Keyword

Turner Syndrome; Estrogen; Hormone Replacement Therapy; Bone Mineral Density; Mosaicism

Figure

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  Fig. 1 Lumbar spine L1–L4 BMD of Turner syndrome women compared to healthy Korean women according to age.BMD = bone mineral density.

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  Fig. 2 Lumbar spine L1–L4 BMD of TS women compared to healthy Korean women.BMD = bone mineral density, TS = Turner syndrome.

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  Fig. 3 Femur neck BMD of Turner syndrome women compared to healthy Korean women according to age.BMD = bone mineral density.

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  Fig. 4 Femur neck BMD of TS women compared to healthy Korean women.BMD = bone mineral density, TS = Turner syndrome.

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  Fig. 5 Annual lumbar spine bone mineral density change rate according to estrogen replacement therapy start age.

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  Fig. 6 Annual femur neck bone mineral density change rate according to estrogen replacement therapy start age.

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  Fig. 7 Effect of estrogen replacement therapy duration on lumbar spine bone mineral density.

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  Fig. 8 Effect of estrogen replacement therapy duration on femur neck bone mineral density.

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  Fig. 9 Lumbar spine BMD according to the karyotype.BMD = bone mineral density.

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  Fig. 10 Femur neck BMD according to the karyotype.BMD = bone mineral density.

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