Zuckerman-Levin Nehama, Yaniv Irit, Schwartz Tseela, Guttmann Hadassah, Hochberg Ze'ev
Pediatric Endocrinology, Meyer Children's Hospital, Rambam Medical Center, Haifa, Israel.
Clin Endocrinol (Oxf). 2007 Jul;67(1):60-4. doi: 10.1111/j.1365-2265.2007.02835.x. Epub 2007 Apr 16.
Patients with Turner's syndrome have normal bone mineral density by dual energy X-ray absorptiometry (DXA), but a predisposition for fractures. Quantitative ultrasonography (QUS) measures cortical bone strength.
To compare QUS with DXA in patients with Turner's syndrome.
Twenty-seven Turner's syndrome patients, aged 21.1 +/- 6.3 years (mean +/- SD), were evaluated by DXA, measuring two-dimensional bone mineral density (BMD), and QUS, measuring speed of sound (SOS) of the radius and tibia. The results were compared to sex- and age-matched (Ctr A, n = 53) and height-matched (Ctr B, n = 34) control groups.
Fracture incidence per 1000 women years was 4.76 in Ctr A, 5 in Ctr B and 7.69 in Turner's patients. In Turner's syndrome patients, QUS results were significantly lower than in controls, whereas DXA Z-scores were not different from reference values. Correlation between tibia and radius SOS and height and age in controls (P < 0.0001) was not evident in Turner's syndrome. Oestrogen or growth hormone therapy had no effect on either QUS or DXA parameters.
Bone fragility in Turner's syndrome is reflected by low SOS but not by DXA BMD. Low QUS, which assesses the cortical bone only, supports a defect in cortical bone in Turner's syndrome. Lack of SOS correlation with age, height and hormonal therapy in Turner's syndrome suggests a primary bone defect, rather than enhanced resorption of endocrine origin.
通过双能X线吸收法（DXA）检测发现，特纳综合征患者的骨矿物质密度正常，但却有骨折倾向。定量超声检查（QUS）可测量皮质骨强度。
比较QUS与DXA在特纳综合征患者中的应用情况。
对27例年龄为21.1±6.3岁（均值±标准差）的特纳综合征患者进行评估，采用DXA测量二维骨矿物质密度（BMD），采用QUS测量桡骨和胫骨的声速（SOS）。将结果与性别和年龄匹配的对照组（对照组A，n = 53）以及身高匹配的对照组（对照组B，n = 34）进行比较。
对照组A每1000女性年的骨折发生率为4.76，对照组B为5，特纳综合征患者为7.69。在特纳综合征患者中，QUS结果显著低于对照组，而DXA Z值与参考值无差异。对照组中胫骨和桡骨SOS与身高和年龄之间的相关性（P < 0.0001）在特纳综合征中不明显。雌激素或生长激素治疗对QUS或DXA参数均无影响。
特纳综合征中的骨脆性通过低SOS反映，而非DXA BMD。仅评估皮质骨的低QUS结果支持特纳综合征中皮质骨存在缺陷。特纳综合征中SOS与年龄、身高及激素治疗缺乏相关性提示存在原发性骨缺陷，而非内分泌源性的吸收增强。
