Session: OR01-Osteoporosis: What You Had, What You Lost, and What You Gain
Room 157 (BCEC)
Aim: To investigate the prevalence and risk factors for low BMD in an established TS cohort.
Method: A retrospective, cross-sectional study of TS patients who underwent DXA scanning at Monash Health, Victoria, Australia from 1998 to 2015. Cases were identified through the hospital Adult TS clinic and Bone Density Department databases. Data from baseline DXA included areal bone mineral density (aBMD) and Z-scores. To adjust for smaller bone size in TS patients, bone mineral apparent density (BMAD) of the lumbar spine (2) and femoral neck (3) was calculated. Low bone mass in young pre-menopausal women was defined as a Z-score < -2.0 (4). Medical history, including ERT and growth hormone therapy (GHT), was collected from medical records. Statistical analysis included descriptive statistics and multivariate regression analysis.
Results: Seventy-nine TS patients were included, and fractures occurred in 30.4% of cases. The median age of TS diagnosis was 11 (range 0-65) years. Primary amenorrhoea was common (81.8%), and the median age of commencing estrogen was delayed at 16 (range 11-46) years. Non-continuous ERT use was reported in 37.9% and GHT was reported in 53%. The median (range) age, height and body mass index was 29 (14-66) years, 148.5 (127.8 – 170.0) cm, and 25.6 (12.4 – 49.5) kg/m2, respectively. The most common osteoporotic risk factor was gonadal failure (89.4%), followed by vitamin D deficiency (40%). Low bone mass in the spine and femoral neck occurred in 26.4% and 7.7%, respectively. Multivariate regression analysis demonstrated that spine and hip aBMD, and BMAD, were inversely associated with age of commencing ERT or years of estrogen deficiency (adjusting for age at DXA and BMI). After adjusting for confounding, GHT was associated with neither aBMD nor BMAD.
Conclusion: Low spinal bone mass is common in TS. Both the delay in commencing estrogen and years of estrogen deficiency are important independent risk factors for reductions in spine and hip bone mass. Avoiding estrogen deficiency is important in optimizing bone health in TS. This depends on early diagnosis of TS to allow age-appropriate pubertal induction and to maximize ERT compliance. Transitional multidisciplinary TS clinics have a role in the early initiation of ERT and in monitoring bone health in TS.
Nothing to Disclose: HN, PW, BJS, PRE, FM, AV
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