Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Horm Res Paediatr 2011;76:193–201 DOI: 10.1159/000329046 Normal Tempo of Bone Formation in Turner Syndrome despite Signs of Accelerated Bone Resorption Line Cleemann   a Kirsten Holm   a Hanne Kobbernagel   b Sven O. Skouby   c Bent Kristensen   b Heidi Smedegaard   a Anna-Maria Andersson   d Arieh Cohen   e Claus H. Gravholt   f   Departments of a  Pediatrics and b  Clinical Physiology, Hillerød Hospital, Hillerød, c  Department of Gynecology and Obstetrics, Herlev University Hospital, Herlev, d  Department of Growth and Reproduction, Copenhagen University Hospital and e  Statens Serum Institut, Copenhagen, and f  Department of Endocrinology and Internal Medicine and the Medical Research Laboratories, Aarhus Sygehus NBG, Aarhus University Hospital, Aarhus, Denmark optimal estradiol replacement therapy and GH according to consensus guidelines, and in controls. Young TS undergoing pubertal induction and still receiving GH have lower z score BMD than older TS patients receiving hormonal replacement therapy, where a near-normalization of BMD was achieved. TS patients previously receiving GH showed signs of in- creased bone resorption. Copyright © 2011 S. Karger AG, Basel Introduction Hypogonadism, increased risk of fractures, reduced bone mineral density (BMD) and osteoporosis are seen in Turner syndrome (TS) [1–4]. Many women with TS do not achieve normal peak bone mass [1, 5, 6]. Dual-energy X-ray absorptiometry (DXA) is commonly used in chil- dren and adults [7], but interpretation in TS is difficult due to an inherent tendency of DXA to underestimate area bone mineral density (aBMD) in short-statured pa- tients [8]. Volumetric BMD (vBMD) has been found nor- mal or near-normal in TS [9–11], but interpretations are challenging due to variations in pubertal status and height disparity during puberty [12]. Key Words Bone mineral density  Turner syndrome  Hormonal replacement therapy  Dual X-ray absorptiometry  Growth hormone Abstract Aims: To evaluate area bone mineral density (aBMD) and vol- umetric BMD (vBMD) by dual-energy X-ray absorptiometry, and relations to bone markers and hormones in adolescent women with Turner syndrome (TS). Methods: Cross-section- al study in TS patients (n = 37, 16.7 8 3.4 years) and control group (n = 49), assessed by dual-energy X-ray absorptiome- try, bone markers and hormones. TS patients were divided into a young group receiving (‘ongoing’) GH (n = 15) and an older group previously receiving (‘previous’) GH (n = 22). Re- sults: vBMD spine was similar in ‘ongoing GH’ TS, but higher in ‘previous GH’ TS, compared to controls. vBMD hip was lower in ‘ongoing GH’ TS, but similar in ‘previous GH’. z scores for aBMD were uniformly reduced in ‘ongoing TS’, but near-nor- malized in ‘previous GH’ TS. Bone formation and resorption markers were increased in ‘ongoing GH’ TS, while ‘previous GH’ TS had elevated bone resorption markers. Conclusion: BMD increased in parallel with age in TS patients receiving Received: November 5, 2010 Accepted: May 4, 2011 Published online: July 26, 2011 HORMONE RESEARCH IN PÆDIATRICS Claus Højbjerg Gravholt, MD, PhD Department of Endocrinology and Internal Medicine Århus Sygehus NBG DK–8000 Aarhus C (Denmark) Tel. +45 8949 2023, E-Mail ch.gravholt  @  dadlnet.dk © 2011 S. Karger AG, Basel 1663–2818/11/0763–0193$38.00/0 Accessible online at: www.karger.com/hrp