Aims: To assess factors associated with excess rates of fractures in women with Turners syndrome.
Settings: Adult Turner Clinic.
Outcome measures: Bone fracture history, oestrogen, growth hormone, oxandrolone and thyroxine therapies, anthropometry, calcium, vitamin D, parathyroid hormone and karyotype, hearing impairment, spinal bone mineral density (BMD). This study was approved by Ethical Committee.
Results: One hundred and seventy-seven consecutive women with Turners syndrome, aged 1960 years, were interviewed with respect to bone fracture history, BMD and hearing information were recorded from medical notes. Karyotype was available in 94% of patients (55% monosomy, 45% mosaicism. Subjects had a mean (S.D.) height of 1.47 (0.07) m and BMI 25.8 (5.2) kg/m2. The prevalence of fractures was 32% and hearing impairment 84.2% (17.5% conductive and 66.7% sensorineual, of whom 32% and 16% used hearing aid, respectively). BMD T score was below −1 in 55% of women and below −2.5 in 9%. More subjects with a combination of conductive hearing impairment and low BMD (57%) had a fracture than those with normal hearing and high BMD (25%) (P <0.05). Multivariate logistic regression analysis (adjusted for age and karyotype) showed BMD (OR 3.2, 95% CI: 1.010.5) and hearing impairment (conductive: OR 4.8, 95% CI: 1.218.9, sensorineural: OR 3.6, 95% CI: 1.111.8) were independently associated with increased risk of fractures. Subgroup analysis showed that hearing impairment was associated with fractures only in those with low BMD (OR 9.0, 95% CI: 1.173.4). Further adjustments for height, calcium levels, vitamin D supplementation, thyroxin use and oestrogen deficiency, previous use of oxandrolone or growth hormone did not alter these relationships.
Conclusions: Women with Turners syndrome who have low BMD and hearing impairment, particularly conductive type, are at increased risk of bone fractures. Improvement of BMD and hearing ability may help reduce their fracture risk.
01 - 05 Apr 2006
European Society of Endocrinology