Passeri M. Longitudinal study of bone loss after thyroidectomy and suppressive thyroxine therapy in premenopausal women. Acta Endocrinol 1992:126:238-42. The effects of suppressive doses of L-thyroxine on the appendicular and axial bone mineral content were followed for 12\p=n-\36 months after total or subtotal thyroidectomy in 15 premenopausal women. Compared to age-matched controls, these patients had a more marked bone loss of the spinal bone mineral content (2.6 \m=+-\1.9% vs 0.2 \m=+-\ 1.2% per year). The changes in radial cortical bone density were not significantly different from the control group. We conclude that when a suppressive therapy with L-thyroxine is necessary the rate of bone loss should be monitored at regular intervals.Suppressive doses of L-thyroxine. a common form of therapy after thyroidectomy for different thyroid dis¬ eases, prevent further growth of abnormal tissue. Patients taking suppressive doses of L-thyroxine fre¬ quently have elevated serum thyroxine and free thyrox¬ ine concentrations, but serum triiodothyronine levels are within the normal range ( 1 ). These patients do not usually show biological or clinical signs of hyperthyroidism, but controversy exists as to whether such patients might have adverse tissue effects (2, 3). Thyroid hor¬ mones have important effects on bone metabolism and hyperthyroidism alters the bone remodelling activity and increases mainly cortical bone porosity, even if trabecular volume and cortical width may also be reduced (4). Cross-sectional studies have shown a reduction in bone density after prolonged suppression of the pituitary-thyroid axis with L-thyroxine (5-7) and marked bone mineral changes have been observed also under replacement therapy in hypothyroidism (8,9).The bone effects of thyroid hormone therapy could be particularly important in thyroidectomized patients in whom a decrement of calcitonin secretion, a potentially protective factor for bone (10), occurs.The aim of this longitudinal study was to assess the effects of suppressive doses of L-thyroxine on the appen¬ dicular and axial bone mineral content in premenopau¬ sal thyroidectomized women. Materials and methodsThe subjects for the study were chosen from all the premenopausal women consecutively admitted during the course of one year for thyroidectomy and were candidates for suppressive therapy. Criteria for exclusion were the presence of other medical disorders, the use of drugs known to interfere with bone and mineral metab¬ olism or previous treatment with thyroid hormones.Fourteen premenopausal women (age: 43 ±6.8 years) undergoing thyroidectomy for goiter (N = 6) and carcinoma (N = 8) were recruited. All the patients were euthyroid at the time of the study. Each subject gave written informed consent to the study.Ten patients underwent near-total thyroidectomy and four subtotal thyroidectomy. All were normally men¬ struating before and throughout the study. After surgery the women began a suppressive therapy with L-thyrox¬ ine. The initial dose was 150¿ug/day (3 ¿tg-kg^-day-1...

Though the chronic use of opiates can modify several body functions, only a few data are available on the effects of opioid drugs on mineral metabolism. We have examined the possible consequences of chronic opiate abuse on bone mass, bone turnover and calcium metabolism in 13 male chronic heroin users, examined 1–2 days after the last administration of the drug (group A), 14 former male heroin addicts, examined 4–24 months after drug discontinuation (group B), and 22 healthy, age- and sex-matched control subjects. In group A, the vertebral bone mineral density (measured by Dual-Photon Absorptiometry) was significantly lower (p <0.05) than in the control subjects, despite similar values of total body bone mineral, lean body and fat mass. Blood-ionised calcium and urinary calcium and hydroxyproline were significantly increased (p<0.01), whereas parathyroid hormone was lower than in controls (p<0.01). Bone alkaline phosphatase and osteocalcin, however, were not significantly different from the control values. LH and testosterone levels were low (p <0.01 vs controls). In contrast, group B subjects did not show significant differences from the control group. The chronic abuse of opioid drugs may be associated with altered bone metabolism and reduced trabecular bone mass, attributable, at least in part, to gonadal deficiency. These alterations seem reversible after drug discontinuation.

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The aim of this research was to establish the importance of calcium intake through mineral water on vertebral bone density in women. To this purpose, we examined 255 women divided into two groups: those regularly drinking a high calcium content mineral water (group A; no.=175) and those using different type of water with a lower calcium content (group B; no.=80). Their dietary daily calcium intake was determined by means of a validated questionnaire (N.I.H. Consensus statement) and vertebral bone density was measured by Dual-Energy X-ray absorptiometry (Unigamma-plus ACN densitometer). Women in group A ingested a significantly higher quantity of calcium in water than women in group B (mean difference 258 mg; 95% confidence limits: 147-370 mg). The average bone density values were slightly but significantly higher in group A as compared to group B (mean+/-SD: 1.044+0,15 vs 1.002+0,14; p=0.03). In addition to age, BMI and menopausal status, calcium intake was a significant predictor of spinal BMD. These 4 variables explained about 35% of the spinal BMD variance. When the analysis was repeated separately for pre- and post-menopausal subjects, calcium remained a significant predictor in post-menopausal women (t=2.28; p=0.02), but not in premenopausal women. These results underline the importance of a lifelong daily calcium intake, resulting by the regular drinking of high bioavailable calcium water, in order to maintain bone mass after the menopause, in comparison to the use of a lower content calcium water.

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