TS & Osteoporosis

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Osteoporosis is 1.4 to 2.2 times higher in TS than in the general population of women.

Heightened Incidence of Osteoporosis in TS

Those affected by Turner syndrome often suffer from low bone density and a high risk of fracture. These conditions can be caused by several different factors associated with TS, including ovarian insufficiency, celiac disease, vitamin D deficiency, and intrinsic bone abnormalities (Augoulea et al., 2019).

What is Osteopenia and Osteoperosis?

Image by AllSpine.

One key feature that has been associated with TS is lower bone mineral density, increasing the chances that someone with TS will develop osteopenia or osteoporosis.  

Although most are familiar of the term osteoporosis, osteopenia may be new to some. Osteopenia is when your bones are thinner, but not to the point they are easy to break, which is the osteoporosis stage. 

The occurs when your body is deteriorating more bone as minerals to the bloodstream than it is creating. You are more likely to face osteopenia as a woman, and the risk is even higher if you have TS.

Common symptoms include:

  • Pain in bone and muscles (mainly in back area)
  • Loss of height
  • Spine malformations
  • Fractures to the hip or wrist are common indicators

Assessing the Risks

Bone density and quality assessment methods are used to assess bone health. One of the most common methods is called DEXA. It measures the attenuation of x-ray beams as they pass through tissues of varying density to indicate the severity of bone degradation.  

The parts of the body that should be measured are the lumbar spine, distal radius, and proximal femur. The whole body should be measured in adults, and children should have the lumbar spine or total body less head (TBLH) measured.

DEXA is fast, safe, and uses low levels of radiation. However, the results can sometimes be difficult to examine due to the small stature and consequently, smaller bone size, seen in women with TS.

Interpreting DEXA Results:

Image by True North Wellness.

Therefore, a variety of other methods exist in order to accustom to the patient. Here are a few:

  • QCT – quantitative computed tomography scan (Evaluation of Bone Health/Bone Density Testing, 2022)


  • pQCT – peripheral quantitative computed tomography scan (Peripheral Quantitative Computed Tomography (pQCT, HR-pQCT) – SCIRE Professional, 2022)


  • TBS (Trabecular Bone Score, which is an index that evaluates variations seen in the DXA image of the lumbar spine (Rajan, 2020)

Takeaway: What Can We Do to Prevent and Treat Osteoperosis?

As our website states, “the goals of managing the disease are to decrease pain, prevent fractures, and minimize further bone loss.” Many of the methods used to treat osteoporosis are to prevent it from worsening. Increasing walking, weight-bearing exercises, and maintaining proper intake of Vitamin D and calcium all help to strengthen bones and to slow bone loss.

Various medications can help to preserve bone health, including estrogen replacement therapy (ERT), which is a common treatment for women with TS. “ERT has proven to reduce bone loss, increase bone density, and reduce the risk of hip and spinal fractures in postmenopausal women,” (Turner Syndrome Foundation). FDA approved medications for osteoporosis include Alendronate, Risedronate sodium (Actonel®), and Raloxifene (Evista®).

For adolescent TS girls whose bone plates (epiphyses) are still open, the combination of growth hormone in addition to estrogen is important for building a good “bone bank”.

As always, it is necessary to discuss maintaining healthy bone mineral density and options for treating osteoporosis with your endocrinologist. 


What Is Osteopenia? (2024, May 19). WebMD. https://www.webmd.com/osteoporosis/guide/osteopenia-early-signs-of-bone-loss

Augoulea, A., Zachou, G., & Lambrinoudaki, I. (2019). Turner syndrome and osteoporosis. Maturitas, 130, 41–49. https://doi.org/10.1016/j.maturitas.2019.09.010

Administrator. (2024, April 29). Home – Bone Health & Osteoporosis Foundation. Bone Health & Osteoporosis Foundation. https://americanbonehealth.org/bonesense-articles/qct-vs-dxa-for-diagnosing-osteoporosis/)

Peripheral Quantitative Computed Tomography (pQCT, HR-pQCT) – SCIRE Professional. (2022, July 29). SCIRE Professional. https://scireproject.com/evidence/bone-health/bone-outcome-measures/imaging-modalities/peripheral-quantitative-computed-tomography-pqct-hr-pqct/#:~:text=General%20Discussion-,Peripheral%20Quantitative%20Computed%20Tomography%20(pQCT%2C%20HR%2DpQCT),volume%20in%20g%2Fcm3.

Rajan, R., Cherian, K. E., Kapoor, N., & Paul, T. V. (2020). Trabecular Bone Score-An Emerging Tool in the Management of Osteoporosis. Indian journal of endocrinology and metabolism, 24(3), 237–243. https://doi.org/10.4103/ijem.IJEM_147_20

Webinar Estrogen Alexandrou
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We are thankful to doctors, such as Eirene Alexandro, MD, who share their expertise and support this cause as a sustaining professional member.

Written by Janae Bunn, TSF volunteer blog writer. Edited and designed by Riya Ajmera, TSF Blog Coordinator.

© Turner Syndrome Foundation, 2024

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