Impact of Clinical Factors on BoneMicroarchitecture in Patients with TurnerSyndrome

Introduction: Patients affected by Turner syndrome (TS) suffer from bone fragility and a high risk of fractures. The health of bone microarchitecture has proven to be a very important element in reducing the risk of fractures. The present study aimed to describe bone characteristics of patients with TS and highlight clinical factors that can influence bone microarchitecture, evaluated by the trabecular bone score (TBS). Methods: This single-centre retrospective study included 41 patients with TS who attended the Endocrinology Day Hospital of the CTO Hospital of Rome between 2016 and 2024. Anthropometric, clinical, and densitometric data were collected and analysed using unadjusted univariate models, age- and body mass index-adjusted models, and multivariate analysis to investigate their effects on TBS. Results: There was a positive association between TBS and duration of estrogen replacement therapy (ERT). Patients who were constantly treated with ERT showed higher bone mineral density (BMD) at the lumbar spine and femoral neck (p=0.026 and p=0.040, respectively) and TBS (p=0.031). The presence of metabolic diseases appeared to have a negative influence on TBS (p=0.034). Discussion: Patients regularly treated with ERT show significantly higher BMD and TBS levels. The diagnosis of metabolic diseases appears to affect bone microarchitecture detrimentally Conclusion: Healthcare providers should pay particular attention to timely ERT and the prevention of metabolic complications, since these are the main factors that appear to improve bone architecture in this specific population.