Bone Health and Psychological Wellbeing in Turner Syndrome: A Tertiary Healthcare Centre Experience from North India

There is a paucity of data in literature on assessment of bone health and psychological health among Turner syndrome (TS) from India and worldwide. Delayed detection and management may have long-term adverse effects on bone and psychological health in TS.

Karyotype proven TS (n: 67) attending the endocrinology outpatient department were included. Bone mineral density was performed by DXA scan. Psychological assessment using GAD7 (Anxiety) and PHQ9 (Depression) questionnaire was done and compared with healthy and type 1 diabetes controls.

Height-age unadjusted low areal bone mineral density (aBMD; Z score ≤-2.0) was found in 61% of all TS subjects. Height-age adjustment for aBMD in subjects with age ≤20 years reduced low aBMD Z-score frequency from 52% to 12%. The patients with menarche or oestrogen replacement for >2 years had a significantly higher bone mineral apparent density (BMAD) compared to prepubertal or patients with hormone replacement therapy for less than 2 years [mean (sd) at spine; 0.243 (0.03) vs. 0.21 (0.02) gm/cm³; P = 0.03]. Mild to severe anxiety and depression in TS subjects was significantly higher than that in healthy controls (P = 0.038 and P = 0.007) but not different than that in type 1 diabetic controls.

Low bone mineral density is a frequent finding in TS, especially with advancing age. Height-age adjustment for aBMD Z-score should be done for younger patients. Timely and appropriate oestrogen therapy can maintain appropriate bone health. Anxiety and depression were often unnoticed but were present in a significant number of patients.