Table 1.

BMD measurements in TS patients.

Population Sample (n)	Age (years)	BMD measurement	Outcome	Reference
40 TS patients	16–45	DXA at the lumbar spine and femoral neck	Subjects with TS and those with primary amenorrhea had severe osteopenia compared with healthy controls	Davies et al. (8)
40 subjects with primary amenorrhea
40 healthy controls
9 TS patients with spontaneous puberty	14.9 ± 1.3	DXA at the lumbar spine	BMD values were in the normal range in TS patients with spontaneous puberty and in the osteopenia range in puberty induced group.	Carrascosa et al. (17)
18 puberty induced TS patients (adolescent)	16.8 ± 0.7
10 puberty induced TS patients (young adult)	20.9 ± 0.7
21 GH and estrogen treated TS patients	19.5 ± 2.3	pQCT at the distal metaphysis and at the proximal diaphysis	BMC was decreased, resulting in a low total vBMD. This was due to decreased cortical thickness at both sites of measurement, whereas trabecular vBMD of the metaphysis was normal	Bechtold et al. (13)
40 TS patients	34.0 ± 11.0	DXA at the lumbar spine and femoral neck	Mean areal bone density was significantly lower at the lumbar spine and femoral neck in TS women than in controls	Bakalov et al. (11)
43 controls	32.0 ± 8.0
23 GH-treated TS patients	21.5 ± 9.4	DXA at RAD-1/3, RAD-UD, AP spine L1–L4, total hip	There was no significant difference in the two groups in BMD or BMAD at the wrist, hip, spine, or whole-body BMC	Bakalov et al. (18)
23 non-GH-treated TS patients	21.7 ± 9.4
68 TS patients belonging to three age groups with different rGH treatment	6.1 ± 2.1	Phalangeal radiographic absorptiometry	Most untreated young TS patients have a normal vBMD. During 7 years of GH treatment the BMD SD score increased significantly	Sas et al. (19)
	6.7 ± 2.4
	6.5 ± 2.4
60 TS patients	36.7 ± 9.6	DXA at the lumbar spine (L2–L4), the hip (femoral neck and trochanteric region), and the non-dominant forearm	BMC and aBMD were universally reduced in TS, whereas vBMD was slightly reduced in the spine	Granvholt et al. (3)
59 controls	36.0 ± 9.5
50 TS patients	30–59	DXA at the lumbar spine (L2–L4); QCT at vertebral bodies L1–L2	Lumbar spine BMD was significantly reduced in women not taking ERT according to current guidelines	Hanton et al. (20)
21 TS patients	20–40	DXA at the lumbar spine and proximal femur	The bone mineral density at the lumbar spine and proximal femur increased after 3 years of HRT	Khastgir et al. (21)
16 TS patients	29.1 ± 5.2	DXA at the lumbar spine (L1–L4) and of whole body	BMD of lumbar spine and whole body of TS were significantly lower than age-matched normal subjects	Suganuma et al. (22)
83 TS patients	12.76 ± 4.4	TB, LS, and FN DXA	The results show a height-independent prepubertal decrease in bone mass accrual, which ceased with puberty	Högler et al. (23)
22 TS patients	12.7 ± 3.8	DXA at the lumbar spine and femur and pQCT scanning of the non-dominant forearm, distal metaphyseal site, and the proximal diaphysis of radius	TS is associated with reduced BMAD at the femoral neck; pQCT data suggest that cortical density is reduced with sparing of trabecular bone	Holroyd et al. (12)
21 controls	12.9 ± 3.8
67 TS patients	6.0–19.4	pQCT at the non-dominant radius	Cortical vBMD was decreased in all TS patients. Height-, age-, and cortical thickness-adjusted cortical vBMD were positively correlated with the duration of GH therapy and to estrogen administration. Girls with a history of fractures had lower total vBMD at the metaphysis compared to non-fractured TS girls	Soucek et al. (14)
32 TS patients	35 (20–61)	HR-pQCT at non-dominant distal radius and tibia	TS patients had compromised trabecular microarchitecture and lower bone strength at radius and tibia	Hansen et al. (16)
32 controls	36 (19–58)
22 TS patients	10.3 ± 2.2	pQCT at forearm	Trabecular BMD and bone strength index were normal in TS as well as SHOX-D patients. Increased total bone area and thin cortex were observed at the proximal radius for TS and SHOX-D patients	Soucek et al. (24)
10 children with SHOX-D	10.3 ± 2.1
24 adolescent TS patients	17.1 ± 3.1	DXA at the lumbar spine and femoral neck; phalangeal QUS	Adolescents with TS had a normal lumbar vBMD and a reduced vBMD at the femoral neck. Phalangeal QUS represents a useful method to identify subjects with increased fracture risk	Vierucci et al. (25)
60 TS patients belonging to three age groups	5.94 ± 3.27	DXA at the lumbar spine (L2–L4)	Bone impairment was detectable by DXA in subjects aged under 10, although it became more evident with aging	Faienza et al. (26)
	13.51 ± 2.06
	23.45 ± 6.80
88 TS patients with primary amenorrhea	17–58	DXA at the lumbar spine (L2–L4)	TS patients receiving late initiation of HRT had a BMD significantly lower than the early initiation group or spontaneous menstrual cycles group	Nakamura et al. (27)
12 TS patients with spontaneous menstrual cycles	18–40
32 TS patients	15.3 ± 3.2	pQCT at the non-dominant radius and tibia	Whereas the cortical BMD was decreased in the radius, it was increased in the tibia. After correcting the cortical BMD for the partial volume effect, the mean Z-score was normal in the radius in TS. The corrected cortical BMD values were similar in the radius and tibia	Soucek et al. (15)
28 TS patients	17–45	DXA of lumbar spine, hip, and radius and HR-pQCT scans of the radius and tibia	No significant difference in DXA-derived BMD and HR-pQCT micro-architectural parameters was detected between childhood GH treatment compared to no treatment in TS	Nour et al. (10)

AP, anteroposterior; BMC, bone mineral content; BMD, bone mineral density; aBMD, area BMD; vBMD, volumetric BMD; BMAD, bone mineral apparent density; DXA, dual-energy X-ray absorptiometry; TS, Turner syndrome; FN, femoral neck; GH, growth hormone; rGH, recombinant GH; HRT, hormone replacement therapy; LS, lumbar spine; pQCT, peripheral quantitative computed tomography; HR-pQCT, high-resolution pQCT; QUS, quantitative ultrasound; RAD-1/3, one-third proximal radius; RAD-UD, ultradistal radius; TB, total body.