Bone demineralisation in patients with Turner's syndrome

The hypothesis that the demineralisation associated with gonadal dysgenesis is analogous to post-menopausal osteoporosis was investigated. Bone mineral content of the distal forearm was measured in 11 adult patients with Turner's syndrome aged 18 to 57 years. As a group these patients were significantly demineralised (p less than 0.001) when compared with normal subjects. A bimodal distribution of bone mineral was demonstrated, the eight patients below the normal range having a bone mineral content 73% of normal. This may be the usual bone mineral content for a large proportion of Turner's patients. No steady reduction in mineralisation with age was demonstrated. The number of osteoporotic type fractures was obtained from the records of 36 adult patients with Turner's syndrome. From the cumulative total years at risk (770 patient years) from the age of 15 years, it was found that the number of fractures of the distal radius corresponded to the normal premenopausal rather than post-menopausal fracture incidence. The absence of any reduction in bone mineral content with age and no clear evidence of an increase in frequency of fractures both suggest that the demineralisation associated with Turner's syndrome is not analogous to post-menopausal osteoporosis. The regular use of long term oestrogen therapy as a treatment for 'osteoporosis' in these patients is therefore not justified.