{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T03:10:35Z","timestamp":1789096235868,"version":"build-2803163510"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>There is a paucity of data in literature on assessment of bone health and psychological health among Turner syndrome (TS) from India and worldwide. Delayed detection and management may have long-term adverse effects on bone and psychological health in TS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Karyotype proven TS (n: 67) attending the endocrinology outpatient department were included. Bone mineral density was performed by DXA scan. Psychological assessment using GAD7 (Anxiety) and PHQ9 (Depression) questionnaire was done and compared with healthy and type 1 diabetes controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Height-age unadjusted low areal bone mineral density (aBMD; Z score \u2264-2.0) was found in 61% of all TS subjects. Height-age adjustment for aBMD in subjects with age \u226420 years reduced low aBMD Z-score frequency from 52% to 12%. The patients with menarche or oestrogen replacement for &gt;2 years had a significantly higher bone mineral apparent density (BMAD) compared to prepubertal or patients with hormone replacement therapy for less than 2 years [mean (sd) at spine; 0.243 (0.03)\n                      <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                      . 0.21 (0.02) gm\/cm\n                      <jats:sup>3<\/jats:sup>\n                      ;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.03]. Mild to severe anxiety and depression in TS subjects was significantly higher than that in healthy controls (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.038 and\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.007) but not different than that in type 1 diabetic controls.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Low bone mineral density is a frequent finding in TS, especially with advancing age. Height-age adjustment for aBMD Z-score should be done for younger patients. Timely and appropriate oestrogen therapy can maintain appropriate bone health. Anxiety and depression were often unnoticed but were present in a significant number of patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijem.ijem_872_25","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T17:01:54Z","timestamp":1788195714000},"page":"352-356","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Bone Health and Psychological Wellbeing in Turner Syndrome: A Tertiary Healthcare Centre Experience from North India"],"prefix":"10.4103","volume":"30","author":[{"given":"Umesh K.","family":"Sah","sequence":"first","affiliation":[{"name":"Department of Endocrinology, King George Medical University, Lucknow, Uttar Pradesh, India"},{"name":"Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siddhnath","family":"Sudhanshu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"},{"name":"Department of Pediatrics (Pediatric Endocrinology Division), All India Institute of Medical Sciences, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amita","family":"Moirangthem","sequence":"additional","affiliation":[{"name":"Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preeti","family":"Dabadghao","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijayalakshmi","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"R1-20260911","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-17-0430","article-title":"Clinical practice guidelines for the care of girls and women with Turner syndrome: Proceedings from the 2016 Cincinnati international turner syndrome meeting","volume":"177","author":"Gravholt","year":"2017","journal-title":"Eur J Endocrinol"},{"key":"R2-20260911","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1080\/17446651.2020.1834846","article-title":"Monitoring and maintaining bone health in patients with Turner syndrome","volume":"15","author":"Chiarito","year":"2020","journal-title":"Expert Rev Endocrinol Metab"},{"key":"R3-20260911","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/S0015-0282(01)03215-0","article-title":"Factors associated with the reduction of bone density in patients with gonadal dysgenesis","volume":"77","author":"Benetti-Pinto","year":"2002","journal-title":"Fertil Steril"},{"key":"R4-20260911","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1007\/s007740200042","article-title":"Bone mineralization in Turner syndrome: A transverse study of the determinant factors in 58 patients","volume":"20","author":"Costa","year":"2002","journal-title":"J Bone Miner Metab"},{"key":"R5-20260911","doi-asserted-by":"crossref","first-page":"258","DOI":"10.6065\/apem.2244222.111","article-title":"Neurocognitive and psychosocial profiles of children with Turner syndrome","volume":"28","author":"Park","year":"2023","journal-title":"Ann Pediatr Endocrinol Metab"},{"key":"R6-20260911","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s11689-021-09399-6","article-title":"Neurodevelopmental and psychiatric disorders in females with Turner syndrome: A population-based study","volume":"13","author":"Bj\u00f6rlin Avdic","year":"2021","journal-title":"J Neurodev Disord"},{"key":"R7-20260911","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s13312-015-0566-5","article-title":"Revised IAP growth charts for height, weight and body mass index for 5- to 18-year-old Indian children","volume":"52","author":"Khadilkar","year":"2015","journal-title":"Indian Pediatr"},{"key":"R8-20260911","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/S2213-8587(21)00088-7","article-title":"Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: A population-based cohort study","volume":"9","author":"Caleyachetty","year":"2021","journal-title":"Lancet Diabetes Endocrinol"},{"key":"R9-20260911","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.jocd.2019.07.001","article-title":"Executive summary of the 2019 ISCD position development conference on monitoring treatment, DXA cross-calibration and least significant change, spinal cord injury, peri-prosthetic and orthopedic bone health, transgender medicine, and pediatrics","volume":"22","author":"Shuhart","year":"2019","journal-title":"J Clin Densitom"},{"key":"R10-20260911","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1111\/cen.70090","article-title":"DXA derived low bone mass in a cohort of prepubertal eastern indian girls with turner syndrome disappeared following adjustment for short stature","volume":"104","author":"Gargari","year":"2026","journal-title":"Clin Endocrinol (Oxf)"},{"key":"R11-20260911","doi-asserted-by":"crossref","first-page":"4652","DOI":"10.1210\/jc.2010-0677","article-title":"Z-score comparability of bone mineral density reference databases for children","volume":"95","author":"Kocks","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"key":"R12-20260911","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: The GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"key":"R13-20260911","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"key":"R14-20260911","doi-asserted-by":"crossref","first-page":"354","DOI":"10.4103\/psychiatry.IndianJPsychiatry_427_20","article-title":"Psychological impact of COVID-19 lockdown: An online survey from India","volume":"62","author":"Grover","year":"2020","journal-title":"Indian J Psychiatry"},{"key":"R15-20260911","first-page":"68","article-title":"Prevalence of depression and anxiety among male patients with COVID-19 in Lebsayyer Field Hospital, Qatar","author":"Zainal Deen","year":"2021","journal-title":"Qatar Med J 2021"},{"key":"R16-20260911","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1007\/s13312-021-2093-x","article-title":"Karyotype-phenotype correlation in turner syndrome at a single center in eastern India","volume":"58","author":"Mondal","year":"2021","journal-title":"Indian Pediatr"},{"key":"R17-20260911","first-page":"236","article-title":"Growth hormone in turner syndrome","volume":"43","author":"Khadilkar","year":"2006","journal-title":"Indian Pediatr"},{"key":"R18-20260911","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s13633-018-0058-1","article-title":"Mode of clinical presentation and delayed diagnosis of Turner syndrome: A single Centre UK study","author":"Apperley","year":"2018","journal-title":"Int J Pediatr Endocrinol 2018"},{"key":"R19-20260911","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1515\/JPEM.2005.18.11.1111","article-title":"Depression, levels of anxiety and self-concept in girls with Turner's syndrome","volume":"18","author":"Kili\u00e7","year":"2005","journal-title":"J Pediatr Endocrinol Metab"},{"key":"R20-20260911","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1046\/j.1365-2265.1998.00552.x","article-title":"The impact of obesity on cardiovascular risk factors in Turner's syndrome","volume":"49","author":"Elsheikh","year":"1998","journal-title":"Clin Endocrinol (Oxf)"},{"key":"R21-20260911","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1210\/jc.2003-030799","article-title":"Importance of estrogen on bone health in Turner syndrome: A cross-sectional and longitudinal study using dual-energy X-ray absorptiometry","volume":"89","author":"H\u00f6gler","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"key":"R22-20260911","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1111\/cen.14484","article-title":"Starting age of oestrogen-progestin therapy is negatively associated with bone mineral density in young adults with Turner syndrome independent of age and body mass index","volume":"95","author":"Nishigaki","year":"2021","journal-title":"Clin Endocrinol (Oxf)"},{"key":"R23-20260911","doi-asserted-by":"crossref","first-page":"1794","DOI":"10.1002\/jbmr.1624","article-title":"Compromised trabecular microarchitecture and lower finite element estimates of radius and tibia bone strength in adults with turner syndrome: A cross-sectional study using high-resolution-pQCT","volume":"27","author":"Hansen","year":"2012","journal-title":"J Bone Miner Res"},{"key":"R24-20260911","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1007\/s00198-010-1170-0","article-title":"Reduced cortical bone density with normal trabecular bone density in girls with Turner syndrome","volume":"21","author":"Holroyd","year":"2010","journal-title":"Osteoporos Int"},{"key":"R25-20260911","doi-asserted-by":"crossref","first-page":"272","DOI":"10.6065\/apem.2142026.013","article-title":"Recognition of the Y chromosome in Turner syndrome using peripheral blood or oral mucosa tissue","volume":"26","author":"Barbosa","year":"2021","journal-title":"Ann Pediatr Endocrinol Metab"},{"key":"R26-20260911","first-page":"3199","article-title":"Occurrence of gonadoblastoma in females with Turner syndrome and Y chromosome material: A population study","volume":"85","author":"Gravholt","year":"2000","journal-title":"J Clin Endocrinol Metab"}],"container-title":["Indian Journal of Endocrinology and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijem.ijem_872_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T03:00:27Z","timestamp":1789095627000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijem.ijem_872_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":26,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ijem.ijem_872_25","relation":{},"ISSN":["2230-8210","2230-9500"],"issn-type":[{"value":"2230-8210","type":"print"},{"value":"2230-9500","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2025-09-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-10","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}