Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2018, vol. 27, nr 6, June, p. 759–764

doi: 10.17219/acem/74598

Publication type: original article

Language: English

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The assessment of skeletal status in young patients with Turner syndrome by 2 densitometric techniques: Phalangeal quantitative ultrasound and dual energy X-ray absorptiometry

Beata Wikiera1,A,B,C,D,F, Agata Mierzwicka2,B,C, Aleksander Basiak1,A,B,C, Jowita Halupczok-Żyła2,B,C, Diana Jędrzejuk2,A,B,C, Magdalena Cabała3,B, Anna Noczyńska1,A,E, Marek Bolanowski2,A,E,F, Kornel Mikołajczyk4,B,E, Zenon P. Halaba5,A,B,C,D,E,F

1 Department and Clinic of Endocrinology and Diabetology for Children and Adolescents, Wroclaw Medical University, Poland

2 Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Poland

3 Department of Pediatrics, Division of Propedeutics of Pediatrics and Rare Disorders, Wroclaw Medical University, Poland

4 Faculty of Rehabilitation, The Józef Piłsudski University of Physical Education in Warsaw, Poland

5 Department of Medical Simulation, University of Opole, Poland

Abstract

Background. Studies using dual energy X-ray absorptiometry (DXA) demonstrate a reduction in bone mineral density (BMD) in children and adolescents with Turner syndrome (TS). However, these studies do not take into account changes in bone size, which influence BMD in the case of short-statured patients. Phalangeal quantitative ultrasound (phQUS) measurements have shown an ability to reveal changes due to skeletal growth, aging, and bone and mineral disorders. There is limited data on bone mineral status in girls with TS assessed by 2 different techniques, i.e., DXA and phQUS.
Objectives. The aim of this study was to investigate the potential negative impact of TS on bone status and to assess whether densitometric values were related to former fractures.
Material and Methods. In 43 TS girls aged 5–18 years, we evaluated bone status by 2 different densitometric techniques, DXA and phQUS.
Results. The mean lumbar spine areal bone mineral density (LS aBMD) Z-score was significantly lower than 0 (the hypothetical mean) compared to the reference population (p < 0.001). The mean LS aBMD height-adjusted Z-score did not differ significantly from 0. The amplitude-dependent speed of sound (Ad-SoS) Z-score was significantly lower than 0 compared with a Polish reference population. There were no significant differences between fractured and fracture-free patients as regards Ad-SoS Z-score and LS aBMD height-adjusted Z-score.
Conclusion. Girls with TS have normal bone density adjusted for height, but significantly decreased phQUS values. Neither DXA nor phalangeal Ad-SoS can identify young TS patients with former fractures.

Key words

fractures, quantitative ultrasound, Turner syndrome, dual energy X-ray absorptiometry

References (23)

  1. Gravholt CH, Vestergaard P, Hermann AP, Mosekilde L, Brixen K, Christiansen JS. Increased fracture rates in Turner’s syndrome: A nationwide questionnaire survey. Clin Endocrinol. 2003;59:89–96.
  2. Ross JL, Long LM, Feuillan P, Cassorla F, Cutler GB Jr. Normal bone density of the wrist and spine and increased wrist fractures in girls with Turner’s syndrome. J Clin Endocrinol Metab. 1991;73:355–359.
  3. Saggese G, Baroncelli GI, Bertoelloni S, Barsanti S. The effect of long-term growth hormone (GH) treatment on bone mineral density in children with GH deficiency. Role of GH in the attainment of peak bone mass. J Clin Endocrinol Metab. 1996;81:3077–3083.
  4. Conway GS, Szarras-Czapnik M, Racz K, et al. Treatment for 24 months with recombinant human GH has a beneficial effect on bone mineral density in young adults with childhood-onset GH deficiency. Eur J Endocrinol. 2009;160(6):899–907.
  5. Aycan Z, Cetinkaya E, Darendeliler F, et al. The effect of growth hormone treatment on bone mineral density in prepubertal girls with Turner syndrome: A multicentre prospective clinical trial. Clin Endocrinol (Oxf). 2008;68(5):769–772.
  6. Davies MC, Gulekli B, Jacobs HS. Osteoporosis in Turner’s syndrome and other forms of primary amenorrhoea. Clin Endocrinol. 1995;43: 741–746.
  7. Landin-Wilhelmsen K, Bryman I, Windh M, Wilhelmsen L. Osteoporosis and fractures in Turner syndrome: Importance of growth promoting and oestrogen therapy. Clin Endocrinol. 1999;51:497–502.
  8. Nadeem M, Roche EF. Bone health in children and adolescent with Turner syndrome. J Pediatr Endocrinol Metab. 2012;25:823–833.
  9. Holroyd CR, Davies JH, Taylor P, et al. Reduced cortical bone density with normal trabecular bone density in girls with Turner syndrome. Osteoporos Int. 2010;21:2093–2099.
  10. Pluskiewicz W, Łuszczyńska A, Halaba Z, Drozdzowska B, Sońta-Jakimczyk D. Skeletal status in survivors of childhood acute lymphoblastic leukemia assessed by quantitative ultrasound: A pilot cross-sectional study. Ultrasound Med Biol. 2002;28:1279–1284.
  11. Pluskiewicz W, Adamczyk P, Drozdzowska B, Pyrkosz A, Halaba Z. Quantitative ultrasound and peripheral bone densitometry in patients with genetic disorders. Ultrasound Med Biol. 2006;32:523–528.
  12. Halaba ZP. The usefulness of phalangeal quantitative ultrasound in the assessment of skeletal status in children and adolescents. Curr Med Imaging Rev. 2008;4:194–201.
  13. Drozdzowska B, Pluskiewicz W, Halaba Z, Misiołek H, Beck B. Quantitative ultrasound at the hand phalanges in 2850 females aged 7 to 77 yr: A cross-sectional study. J Clin Densitom. 2005;8(2):216–221.
  14. Halaba ZP, Pluskiewicz W. Quantitative ultrasound in the assessment of skeletal status in children and adolescents. Ultrasound Med Biol. 2004;30(2):239–243.
  15. Eunice Kennedy Shriver National Institute of Child Health and Human Development: Bone mineral density in childhood study. https://bmdcs.nichd.nih.gov/zscore.htm Accessed December 14, 2015 – April 10, 2016.
  16. Zemel BS, Leonard MB, Kelly A, et al. Height adjustment in assessing dual energy X-ray absorptiometry measurements of bone mass and density in children. J Clin Endocrinol Metab. 2010;95:1265–1273.
  17. Landin LA. Fracture patterns in children. Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950–1979. Acta Orthop Scand Suppl. 1983;202:1–109.
  18. Gravholt CH, Lauridsen AL, Brixen K, Mosekilde L, Heickendorff, Christiansen JS. Marked disproportionality in bone size and mineral, and distinct abnormalities in bone markers and calcitropic hormones in adult Turner syndrome: A cross-sectional study. J Clin Endocrinol Metab. 2002;87:2798–2808.
  19. Bakalov V, Chen M, Baron J, et al. Bone mineral density and fractures in Turner syndrome. Am J Med. 2003;115(4):259–264.
  20. Hansen S, Brixen K, Gravholt CH. Compromised trabecular microarchitecture and lower finite element estimates of radius and tibia bone strength in adults with turner syndrome: A cross-sectional study using high-resolution-pQCT. Bone Miner Res. 2012;27(8):1794–1803.
  21. Nour MA, Burt LA, Perry RJ, Stephure DK, Hanley DA, Boyd SK. Impact of growth hormone on adult bone quality in Turner syndrome: A HR-pQCT study. Calcif Tissue Int. 2016;98(1):49–59.
  22. Bechtold S, Rauch F, Noelle V, et al. Musculoskeletal analyses of the forearm in young women with Turner syndrome: A study using peripheral quantitative computed tomography. J Clin Endocrinol Metab. 2001;86:5819–5823.
  23. Bakalov VK, Axelrod L, Baron J, et al. Selective reduction in cortical bone mineral density in Turner syn
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