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Szybiak W, Kujawa B, Miedziaszczyk M, Lacka K. Effect of Growth Hormone and Estrogen Replacement Therapy on Bone Mineral Density in Women with Turner Syndrome: A Meta-Analysis and Systematic Review. Pharmaceuticals (Basel) 2023; 16:1320. [PMID: 37765128 PMCID: PMC10536543 DOI: 10.3390/ph16091320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/27/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Osteoporosis is a serious implication of Turner syndrome (TS). Common methods for the treatment of TS are growth hormone (GHT) and estrogen replacement therapy (ERT). We examined the relationship between the treatment of TS and bone mineral density (BMD) of the lumbar spine. The purpose of our study was to show the currency of BMD states among patients with TS for treatment with GHT and ERT. We searched databases for studies published from inception to April 2023. The articles were related to TS, osteoporosis, ERT, GHT, BMD and treatment patients with TS. We applied the selection criteria: lumbar spine values at L1-L4; dual-energy X-ray absorptiometry (DXA); treatment which was applied: one group of articles: ERT and two group of articles: GHT; results performed as means ± SD. In total, 79 articles were analyzed, of which 20 studies were included and 5 were considered for meta-analysis. The total number of women in the articles selected was 71. Based on the results of the meta-analysis, the effect of ERT on BMD demonstrated a significant increase in BMD (the standardized mean difference in the random model was 0.593 g/cm2, 95% CI: 0.0705 to 1.116; p = 0.026), which showed that treatment with estrogen particularly increases bone mass during treatment, which contributes to reducing the risk of fractures. The effect of GHT on BMD demonstrated a non-significant decrease in BMD in patients with TS. The results for growth hormone show that this therapy does not improve bone density. However, our review emphasizes the beneficial effect of supplementing growth hormone (GH) on the clinical presentation of TS.
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Affiliation(s)
- Weronika Szybiak
- Students’ Scientific Section at the Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Science, 60-355 Poznan, Poland; (W.S.); (B.K.)
| | - Barbara Kujawa
- Students’ Scientific Section at the Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Science, 60-355 Poznan, Poland; (W.S.); (B.K.)
| | - Miłosz Miedziaszczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Science, 60-355 Poznan, Poland;
| | - Katarzyna Lacka
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Science, 60-355 Poznan, Poland
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Uzar I, Bogacz A, Sowińska-Przepiera E, Kotrych K, Wolek M, Sulikowski T, Kamiński A. The influence of ESR1 polymorphisms on selected hormonal, metabolic and mineral balance markers in women with hyperandrogenism. Sci Rep 2022; 12:19712. [PMID: 36385124 PMCID: PMC9668905 DOI: 10.1038/s41598-022-17383-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Hyperandrogenism is the most common endocrine disorder in women, characterized by an imbalance in normal estrogen and androgen levels in the blood. Androgens influence bone mineral density, body mass composition, muscle mass, mental state, and the regulation of sexual function.. The aim of the study was to assess the effect of estrogen receptor α gene (ESR1) polymorphisms on selected markers of bone metabolism and hormonal parameters in women with hyperandrogenism. The study group included 80 young women with hyperandrogenism who underwent measurements of bone mineral density (BMD), and determination of hormonal and metabolic parameters. Enzyme immunoassays were used to measure leptin, sRANKL (soluble receptor activator of nuclear factor-kB ligand), osteoprotegerin and 25-OH vitamin D total levels. An analysis of ESR1 gene polymorphisms was performed using the real-time PCR method. A relationship was demonstrated between the concentration of free estradiol (FEI) and the concentration of 17-OH-progesterone, and the ESR1 gene polymorphisms: rs3020314 (p = 0.031, p = 0.026 respectively) and rs1884051 (p = 0.033, p = 0.026 respectively). In conclusion, the ESR gene polymorphisms may be associated with hormonal disturbances in the concentration of estrogens and androgens, in hyperandrogenism in young women which may indirectly affect bone mineral density. However, no statistically significant relationships between the studied polymorphisms and the selected parameters of mineral metabolism have been demonstrated..
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Affiliation(s)
- Izabela Uzar
- Department of Pharmacology and Pharmacoeconomics, Pomeranian Medical University in Szczecin, 71-230, Szczecin, Poland
| | - Anna Bogacz
- Department of Stem Cells and Regenerative Medicine, Institute of Natural Fibers and Medicinal Plants, 62-064, Plewiska, Poland.
| | - Elżbieta Sowińska-Przepiera
- Department of Endocrinology, Metabolic Diseases, and Internal Diseases, Pomeranian Medical University in Szczecin, 71-252, Szczecin, Poland
| | - Katarzyna Kotrych
- Department of General and Dental Radiology, Pomeranian Medical University in Szczecin, 70-111, Szczecin, Poland
| | - Marlena Wolek
- Department of Stem Cells and Regenerative Medicine, Institute of Natural Fibers and Medicinal Plants, 62-064, Plewiska, Poland
| | - Tadeusz Sulikowski
- General, Mini-Invasive and Gastroenterogical Surgery Clinic, Pomeranian Medical University in Szczecin, 71-252, Szczecin, Poland
| | - Adam Kamiński
- Department of Orthopedics and Traumatology, Independent Public Clinical Hospital No. 1, Pomeranian Medical University, 71-252, Szczecin, Poland
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Scalco RC, Trarbach EB, Albuquerque EVA, Homma TK, Inoue-Lima TH, Nishi MY, Mendonca BB, Jorge AAL. ESR1 polymorphism (rs2234693) influences femoral bone mass in patients with Turner syndrome. Endocr Connect 2019; 8:1513-1519. [PMID: 31671406 PMCID: PMC6893309 DOI: 10.1530/ec-19-0398] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 11/17/2022]
Abstract
Most patients with Turner syndrome (TS) need hormone replacement therapy because of hypergonadotropic hypogonadism; individual outcomes, however, are highly variable. Our objective was to assess the influence of five estrogen receptor 1 gene (ESR1) polymorphisms (rs543650, rs1038304, rs2046210, rs2234693 and rs9340799) on adult height, breast development, uterine volume and bone mineral density (BMD). We studied 91 TS patients from a tertiary hospital using adult estrogen dose. In our group, ESR1 rs2234693 was associated with femoral neck and total hip BMD, and it accounted for around 10% of BMD variability in both sites (P < 0.01). Patients homozygous for C allele in this polymorphism had significantly lower femoral neck BMD (0.699 ± 0.065 g/cm2 vs 0.822 ± 0.113 g/cm2, P = 0.008) and total hip BMD (0.777 ± 0.118 g/cm2 vs 0.903 ± 0.098 g/cm2, P = 0.009) than patients homozygous for T allele. The other four ESR1 polymorphisms were not able to predict any of the above estrogen therapy outcomes in an isolated manner. Patients homozygous for the haplotype GCG formed by polymorphisms rs543650, rs2234693 and rs9340799 had an even more significantly lower femoral neck BMD (0.666 ± 0.049 vs 0.820 ± 0.105 g/cm2, P = 0.0047) and total hip BMD (0.752 ± 0.093 vs 0.908 ± 0.097 g/cm2, P = 0.0029) than patients homozygous for haplotypes with a T allele in rs2234693. In conclusion, homozygosity for C allele in ESR1 rs2234693 and/or for GCG haplotype appears to be associated with lower femoral neck and total hip BMD. We believe that the identification of polymorphisms related to estrogen outcomes may contribute to individualization of treatment in TS.
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Affiliation(s)
- Renata C Scalco
- Unidade de Endocrinologia Genetica, Laboratorio de Endocrinologia Celular e Molecular LIM/25, Disciplina de Endocrinologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Disciplina de Endocrinologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
- Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genetica Molecular LIM/42, Disciplina de Endocrinologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Correspondence should be addressed to R C Scalco:
| | - Ericka B Trarbach
- Unidade de Endocrinologia Genetica, Laboratorio de Endocrinologia Celular e Molecular LIM/25, Disciplina de Endocrinologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Edoarda V A Albuquerque
- Unidade de Endocrinologia Genetica, Laboratorio de Endocrinologia Celular e Molecular LIM/25, Disciplina de Endocrinologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Thais K Homma
- Unidade de Endocrinologia Genetica, Laboratorio de Endocrinologia Celular e Molecular LIM/25, Disciplina de Endocrinologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Thais H Inoue-Lima
- Unidade de Endocrinologia Genetica, Laboratorio de Endocrinologia Celular e Molecular LIM/25, Disciplina de Endocrinologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Mirian Y Nishi
- Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genetica Molecular LIM/42, Disciplina de Endocrinologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Berenice B Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genetica Molecular LIM/42, Disciplina de Endocrinologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Alexander A L Jorge
- Unidade de Endocrinologia Genetica, Laboratorio de Endocrinologia Celular e Molecular LIM/25, Disciplina de Endocrinologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Allybocus ZA, Wang C, Shi H, Wu Q. Endocrinopathies and cardiopathies in patients with Turner syndrome. Climacteric 2018; 21:536-541. [PMID: 30380946 DOI: 10.1080/13697137.2018.1501674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Z. A. Allybocus
- Center of Genetic and Prenatal Diagnosis, Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Henan Province, China
| | - C. Wang
- Center of Genetic and Prenatal Diagnosis, Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Henan Province, China
| | - Hr. Shi
- Center of Genetic and Prenatal Diagnosis, Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Henan Province, China
| | - Qh. Wu
- Center of Genetic and Prenatal Diagnosis, Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Henan Province, China
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Shi K, Liu L, He YJ, Li D, Yuan LX, Lash GE, Li L. Body composition and bone mineral status in patients with Turner syndrome. Sci Rep 2016; 6:38026. [PMID: 27901060 PMCID: PMC5128814 DOI: 10.1038/srep38026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 11/04/2016] [Indexed: 01/15/2023] Open
Abstract
Turner syndrome (TS) is associated with decreased bone mineral density and increased fracture rate. However, the developmental trajectory of bone density or body composition in patients with TS is still unclear. The present study tested the hypothesis that different karyotypes and/or age contributes to abnormal body composition and decreased bone mineral status parameters in patients with TS. This study included 24 girls with TS, in which 13 girls exhibited X0 karyotype and 11 had mosaicism. Quantitative ultrasound (QUS) assessed the bone mineral status of the calcaneus, including bone mineral density (BMD), amplitude-dependent speed of sound (AD-SOS), broadband ultrasound attenuation (BUA) and InBody 770 assessed body composition. Pearson's test was performed to correlate measured parameters with patient age. The body composition and bone mineral status parameters were not significantly influenced by patient karyotype. There was a correlation between patient age and AD-SOS (r = -0.61, P = 0.002) and BUA (r = 0.50, P = 0.013) but not BMD (r = -0.19, P = 0.379). In conclusion, there was no effect of karyotype on body composition or body mineral status. Bone mineral status, as evidenced by changes in AD-SOS and BUA, alters with age regardless of karyotype. The developmental trajectory demonstrated in the current study warrants further validation in a longitudinal study.
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Affiliation(s)
- Kun Shi
- Department of Gynecology and Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, 9 Jingsui Road, Guangzhou, Guangdong, 510160, China
| | - Li Liu
- Department of Pediatrics Endocrinology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, 9 Jingsui Road, Guangzhou, Guangdong 510160, China
| | - Yao-Juan He
- Department of Gynecology and Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, 9 Jingsui Road, Guangzhou, Guangdong, 510160, China
| | - Duan Li
- Department of Pediatrics Endocrinology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, 9 Jingsui Road, Guangzhou, Guangdong 510160, China
| | - Lian-Xiong Yuan
- Department of Biostatistics, Sun Yixian University, 74 Zhong Shan Er Road, Guangzhou, Guangdong, 510515, China
| | - Gendie E. Lash
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, 9 Jingsui Road, Guangzhou, Guangdong, 510160, China
| | - Li Li
- Department of Gynecology and Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, 9 Jingsui Road, Guangzhou, Guangdong, 510160, China
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[Turner syndrome and genetic polymorphism: a systematic review]. REVISTA PAULISTA DE PEDIATRIA 2015; 33:364-71. [PMID: 25765448 PMCID: PMC4620965 DOI: 10.1016/j.rpped.2014.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/27/2014] [Accepted: 11/29/2014] [Indexed: 01/15/2023]
Abstract
Objective: To present the main results of the literature on genetic polymorphisms in Turner
syndrome and their association with the clinical signs and the etiology of this
chromosomal disorder. Data sources: The review was conducted in the PubMed database without any time limit, using the
terms Turner syndrome and genetic polymorphism.
A total of 116 articles were found, and based on the established inclusion and
exclusion criteria 17 were selected for the review. Data synthesis: The polymorphisms investigated in patients with Turner syndrome were associated
with growth deficit, causing short stature, low bone mineral density, autoimmunity
and cardiac abnormalities, which are frequently found in patients with Turner
syndrome. The role of single nucleotide polymorphisms in the etiology of Turner
syndrome, i.e., in chromosomal nondisjunction, was also confirmed. Conclusions: Genetic polymorphisms appear to be associated with Turner syndrome. However, in
view of the small number of published studies and their contradictory findings,
further studies in different populations are needed in order to clarify the role
of genetic variants in the clinical signs and etiology of the Turner syndrome.
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Riancho JA, Hernández JL. Pharmacogenomics of osteoporosis: a pathway approach. Pharmacogenomics 2012; 13:815-29. [PMID: 22594513 DOI: 10.2217/pgs.12.50] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Osteoporosis is frequent in postmenopausal women and old men. As with other prevalent disorders, it is the consequence of complex interactions between genetic and acquired factors. Candidate gene and genome-wide association studies have pointed to several genes as determinants of the risk of osteoporosis. Some of them were previously unsuspected and may help to find new therapeutic targets. Several drugs already available are very effective in increasing bone mass and decreasing fracture risk. However, not all patients respond properly and some of them suffer fragility fractures despite therapy. Investigators have tried to identify the genetic features influencing the response to antiosteoporotic therapy. In this article we will review recent data providing insight into new genes involved in osteoporosis and the pharmacogenetic data currently available.
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Affiliation(s)
- José A Riancho
- Department of Internal Medicine, Hospital UM Valdecilla-IFIMAV, University of Cantabria, Av Valdecilla s/n, Santander 39008, Spain.
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Sowińska-Przepiera E, Syrenicz A, Friebe Z, Jarząbek-Bielecka G, Chełstowski K. PvuII and XbaI polymorphisms of estrogen receptor-α and the results of estroprogestagen therapy in girls with functional hypothalamic amenorrhea - preliminary study. Arch Med Sci 2012. [PMID: 23185193 PMCID: PMC3506227 DOI: 10.5114/aoms.2012.31133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The aim of this study was the long-term prospective evaluation of the effects of estroprogestagen (EP) therapy on the bone mineral density (BMD) of girls with functional hypothalamic amenorrhea (FHA) carrying various PvuII and XbaI polymorphisms of ER-α. MATERIAL AND METHODS Prospective observation included 84 FHA girls and 50 controls. The FHA patients were subjected to 4-year sequential therapy with 17β estradiol (2 mg from the 2(nd) to 25(th) day of the menstrual cycle) and dydrogesterone (10 mg from the 16(th) to the 25(th) day). Hormonal parameters, serum concentration of the bone fraction of alkaline phosphatase (BALP), urine concentration of cross-linked n-telopeptide of type I collagen (Ntx) and BMD were determined before and after the treatment. RESULTS Six-month treatment resulted in a marked increase in estradiol (p = 0.001), testosterone and prolactin levels (p = 0.01 both) and a significant decrease in BALP and Ntx (p = 0.001 both). Patients with the PP polymorphism had significantly lower baseline BMD compared to carriers of other polymorphic variants of PvuII (p = 0.003). A significant increase in BMD was observed throughout the entire therapy period, with no significant differences in the yearly dynamics of BMD changes observed amongst various polymorphic variants and haplotypes of ER-α. CONCLUSIONS The EP therapy is effective in the treatment of BMD disorders associated with FHA, and treatment results do not depend on PvuII and XbaI polymorphisms of ER-α.
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Affiliation(s)
- Elżbieta Sowińska-Przepiera
- Department of Endocrinology, Metabolic Diseases and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
- Department of Gynecology, Poznan University of Medical Sciences, Poland
| | - Anhelli Syrenicz
- Department of Endocrinology, Metabolic Diseases and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Zbigniew Friebe
- Department of Gynecology, Poznan University of Medical Sciences, Poland
| | | | - Kornel Chełstowski
- Department of Laboratory Diagnostics and Molecular Medicine, Pomeranian Medical University, Szczecin, Poland
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