Height-Age Adjustment Reduces Low Bone Mass Prevalence in Young Patients from 52% to 12%, Study Finds

Although Turner syndrome (TS) exhibits a wide clinical spectrum, data on bone health and psychological well-being remain scarce because prior studies yielded conflicting bone density results without adjusting for stature and overlooked emotional comorbidities. To address this gap, Dr. Umesh K. Sah and Dr. Siddhnath Sudhanshu from Sanjay Gandhi Postgraduate Institute of Medical Sciences evaluated stature-adjusted bone mineral density and psychological health to improve comprehensive care.

Therefore, the two-year cross-sectional study evaluated 67 Turner syndrome patients (median age 18) using dual-energy X-ray absorptiometry alongside GAD-7 and PHQ-9 surveys. Excluding individuals with intellectual disability, primary endpoints compared bone density and psychological scores against healthy (n=55) and type 1 diabetes (n=55) controls while evaluating hormone replacement therapy duration.

Key Clinical Findings of the Study Includes:

• Stature-Adjusted Densitometry: Analysis demonstrated that adjusting areal bone mineral density for height-age reduced low bone mass prevalence (Z-score ≤ -2.0) from 52% to 12% in participants aged 20 years or younger.
• Estrogen Therapy Impact: Investigation revealed that patients receiving HRT for over two years achieved significantly higher bone mineral apparent density (BMAD) than those treated for two years or less (0.243 vs. 0.210 g/cm³, P = 0.03).
• Psychological Distress Rates: Assessment showed that TS subjects experienced significantly higher mild-to-severe anxiety (36% vs. 16%, P = 0.038) and depression (44% vs. 18%, P = 0.007) than healthy controls.
• Age-Related Bone Deficits: Finding highlighted that unadjusted low areal bone density reached 74% among participants older than 20 years, confirming progressive bone loss with advancing age.

The results suggest that standard DXA scanning without height-age correction overestimates low bone density in young TS individuals from 12% to 52%, whereas appropriate HRT for longer than two years preserves volumetric bone density at 0.243 g/cm³. Furthermore, identifying anxiety and depression burdens remains crucial for improving overall outcomes.

Thus, the study concludes clinicians should routinely apply height-adjusted bone density evaluations and integrate psychological screening into standard care protocols to optimize hormone replacement timing and patient management.

Although constrained by a modest sample size, single-center design, and reliance on Western normative database standards, prospective multi-center studies using volumetric peripheral quantitative computed tomography could further enhance pediatric bone microarchitecture assessment and psychosocial intervention strategies.

Reference

Sah UK, Sudhanshu S, Moirangthem A, Dabadghao P, Bhatia V. Bone health and psychological wellbeing in Turner syndrome: A tertiary healthcare centre experience from North India. Indian J Endocr Metab 2026;30:352-6.