title: Usefulness of phalangeal quantitative ultrasound in identifying reduced bone mineral status and increased fracture risk in adolescents with Turner syndrome.
abstract: OBJECTIVE. Bone health is a major concern in patients with Turner syndrome (TS). There are few studies assessing bone mineral status in TS adolescents and none have reported a clear relationship with the risk of fracture. We assessed bone mineral status at three different skeletal sites by two different densitometric techniques in a group of TS adolescents. DESIGN. In 24 TS adolescents (17.1±3.1 years) we evaluated lumbar and femoral volumetric bone mineral density (vBMD) with dual energy X-ray absorptiometry (DXA), amplitude-dependent speed of sound (AD-SoS) and bone transmission time (BTT) with phalangeal quantitative ultrasound (QUS). RESULTS. Mean lumbar vBMD Z-score was normal, while mean femoral vBMD, AD-SoS and BTT Z-score were reduced. 8/24 (33.3%) and 13/24 (54.2%) girls had AD-SoS and BTT ≤-2 Z-score, respectively, while lumbar vBMD and femoral vBMD were ≤-2 Z-score only in 2/24 (8.4%) and 1/24 (4.2%) patients. Overall, we documented 15 fractures (three pathological) in 8 girls. Patients who reported at least one fracture had lower AD-SoS and BTT Z-score values than fracture-free girls. The presence of a value of BTT ≤-2.0 Z-score was associated with a significant OR of positive history of fracture of 11.67 (χ2=5.906, p =0.015, C.I. 95% 1.14-119.54). Lumbar and femoral vBMD were not related to fracture risk. CONCLUSIONS. TS adolescents may have impaired bone mineral status in skeletal sites with predominant cortical bone. Phalangeal QUS represents a useful method to identify subjects with increased fracture risk.
authors: U.O. Pediatria Universitaria, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Pisana; Pisa, Italy.
authors: Francesco
authors: F
authors: Vierucci
authors: U.O. Pediatria Universitaria, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Pisana; Pisa, Italy.
authors: Marta
authors: M
authors: Del Pistoia
authors: U.O. Medicina Nucleare, Dipartimento di Scienze Oncologiche e Radiologiche; Azienda Ospedaliero-Universitaria Pisana; Pisa, Italy.
authors: Paola
authors: P
authors: Erba
authors: U.O. Pediatria Universitaria, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Pisana; Pisa, Italy.
authors: Giovanni
authors: G
authors: Federico
authors: U.O. Pediatria Universitaria, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Pisana; Pisa, Italy.
authors: Giuseppe
authors: G
authors: Saggese
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000367:Age Factors; D015519:Bone Density; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging; D050278:Finger Phalanges / Q000000981:diagnostic imaging*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000209:etiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D014424:Turner Syndrome / Q000150:complications* / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D055815:Young Adult