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Normal Bone Density of the Wrist and Spine and Increased Wrist Fractures in Girls with Turner’s Syndrome

Department of Pediatrics, Medical College of Pennsylvania Philadelphia, Pennsylvania 19129
The Developmental Endocrinology Branch, National Institute of Child Health Bethesda, Maryland 20892
Human Development, National Institutes of Health Bethesda, Maryland 20892

Address requests for reprints to: Judith Levine Ross, M.D., Medical College of Pennsylvania, 3300 Henry Avenue, Philadelphia, Pennsylvania 19129.

Turner’s syndrome is associated with multiple skeletal abnormalities, including osteoporosis. We evaluated the hypothesis that girls with Turner’s syndrome may have deficient bone density before the expected age of pubertal onset (9–13 yr) by comparing the bone mineral content of the wrist and lumbar spine in 78 girls with Turner’s syndrome (4–13 yr old) and 28 normal prepubertal girls who were matched for age, bone age, body mass index, or height age. The bone mineral content of the wrist and spine was measured by single photon absorptiometry (SPA) and dual photon absorptiometry (DPA), respectively. SPA values for girls with Turner’s syndrome vs. normal subjects (4–6.9, 7–9.9, and 10–12.9 yr old) were (mean ± SD) 0.27 ± 0.05 vs. 0.36 ± 0.05, 0.35 ± 0.06 vs. 0.41 ± 0.06, and 0.41 ± 0.05 vs. 0.45 ± 0.03 g/cm², respectively. SPA values in the Turner’s syndrome girls were decreased compared to those in normal prepubertal girls, matched for age (P < 0.0001), bone age, (P < 0.001), and body mass index (BMI; P < 0.0001), but not for height age. DPA values for girls with Turner’s syndrome vs. normal girls in the same age categories were 0.65 ± 0.06 vs. 0.70 ± 0.09, 0.77 ± 0.08 vs. 0.79 ± 0.09, and 0.83 ± 0.12 vs. 0.78 ± 0.07 g/cm². DPA values in Turner’s syndrome girls (as a group) were decreased compared to those in normal prepubertal girls matched for age (P < 0.05) and BMI (P < 0.02), but not for bone age or height age. The annual incidence rate of wrist fractures in Turner’s syndrome girls (9.1 of 1000) was significantly increased compared to the reported annual incidence rate in normal children (3.5 of 1000; P < 0.003).

We conclude that prepubertal-aged girls with Turner’s syndrome (<13 yr old) have normal bone density for height age, but significantly decreased bone density of the wrist for chronological age, bone age, and BMI. They also have significantly more wrist fractures than normal girls, but it is not clear that this is related to their bone density.

Received October 10, 1990.

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