Compromised trabecular microarchitecture and lower finite element estimates of radius and tibia bone strength in adults with turner syndrome: A cross-sectional study using high-resolution-pQCT

• Published in: Journal of bone and mineral research Vol. 27; no. 8; pp. 1794 - 1803
• Main Authors: Hansen, Stinus, Brixen, Kim, Gravholt, Claus H
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.08.2012; Wiley; Oxford University Press
• Subjects: Absorptiometry, Photon; Adolescent; Adult; Anthropometry; Biological and medical sciences; Bone Density; BONE MICROARCHITECTURE; BONE STRENGTH; Case-Control Studies; Cross-Sectional Studies; Female; FINITE ELEMENT ANALYSIS; Fundamental and applied biological sciences. Psychology; HR-PQCT; Humans; Middle Aged; Radius - diagnostic imaging; Radius - pathology; Radius - physiopathology; Regression Analysis; Skeleton and joints; Tibia - diagnostic imaging; Tibia - pathology; Tibia - physiopathology; Tomography, X-Ray Computed; TURNER SYNDROME; Turner Syndrome - diagnostic imaging; Turner Syndrome - pathology; Turner Syndrome - physiopathology; Vertebrates: osteoarticular system, musculoskeletal system; Young Adult; Chromosomal aberration; Human; Radius; Dysgenesia; High resolution; Genital system; Sexual differentiation disorder; FINITE ELEMENT ANALYSIS; Turner syndrome; Female genital diseases; Osteoarticular system; BONE STRENGTH; Vertebrata; Mammalia; Malformation; Gonad; Tibia; Cross sectional study; HR-PQCT; Adult; Bone; BONE MICROARCHITECTURE; Strength
• ISSN: 0884-0431; 1523-4681; 1523-4681
• DOI: 10.1002/jbmr.1624

Although bone mass appear ample for bone size in Turner syndrome (TS), epidemiological studies have reported an increased risk of fracture in TS. We used high‐resolution peripheral quantitative computed tomography (HR‐pQCT) to measure standard morphological parameters of bone geometry and microarchitecture, as well as estimated bone strength by finite element analysis (FEA) to assess bone characteristics beyond bone mineral density (BMD) that possibly contribute to the increased risk of fracture. Thirty‐two TS patients (median age 35, range 20–61 years) and 32 healthy control subjects (median age 36, range 19–58 years) matched with the TS participants with respect to age and body‐mass index were studied. A full region of interest (ROI) image analysis and a height‐matched ROI analysis adjusting for differences in body height between groups were performed. Mean bone cross‐sectional area was lower in TS patients in radius (−15%) and tibia (−13%) (both p < 0.01) whereas cortical thickness was higher in TS patients in radius (18%, p < 0.01) but not in tibia compared to controls. Cortical porosity was lower in TS patients at both sites (−32% in radius, −36% in tibia, both p < 0.0001). Trabecular integrity was compromised in TS patients with lower bone volume per tissue volume (BV/TV) (−27% in radius, −22% in tibia, both p < 0.0001), trabecular number (−27% in radius, −12% in tibia, both p < 0.05), and higher trabecular spacing (54% in radius, 23% in tibia, both p < 0.01). In the height‐matched ROI analysis, differences remained significant apart from total area at both sites, cortical thickness in radius, and trabecular number in tibia. FEA estimated failure load was lower in TS patients in both radius (−11%) and tibia (−16%) (both p < 0.01) and remained significantly lower in the height‐matched ROI analysis. Conclusively, TS patients had compromised trabecular microarchitecture and lower bone strength at both skeletal sites, which may partly account for the increased risk of fracture observed in these patients. © 2012 American Society for Bone and Mineral Research.