Wasserman et al. report increased fracture prevalence in older patients with Turner syndrome (TS).

They conducted a patient-based survey (771 patients, 231 controls), performed in association with national patient advocacy groups in the USA. During childhood, adolescence and young adulthood, there was no difference in fracture prevalence between individuals with TS and controls, whereas older women (>45 years) with TS were more likely to experience fractures than controls without TS (P=0.01). Balance problems were more common in individuals with TS than in controls (26.5 vs 14.8%, P=0.0006).

Oestrogen replacement was started at an older age in the group of patients >25 years of age. The mean age at discontinuation of oestrogen replacement was 36.5±12.5 years, and in the older age group those women discontinuing oestrogen replacement had a higher fracture rate. There was no difference in time of puberty between those who did and did not fracture.

Whilst this paper is a self-reported questionnaire, and not cross-checked with medical notes, its relatively large number of patients provides us with useful information, and supports the continued use of oestrogen replacement in adult life. It also describes an association with balance issues and falls in TS which may be worthy of further investigation.

Read the full article in Clinical Endocrinology 89 46–55