Frax score calculations in postmenopausal women with subclinical hypothyroidism

Polovina, Snežana; Popović, Vera; Duntas, Leonidas H.; Milić, Nataša; Micić, Dragan

doi:10.1007/bf03401309

Cited by 15 publications

(10 citation statements)

References 55 publications

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“…TSH even moderately below or above the reference range is an independent predictive factor for vertebral fractures. 13,15,[19][20][21][22] The HUNT2 study revealed a weak association between mild increase or decrease of TSH and a higher risk of hip fractures, fracture risk being evaluated on the basis of the information given by examiners during the 12.5 years of follow-up. 23 The same study described an association between TSH in the hyperthyroid range and low bone mineral density in the forearm.…”

Section: Discussionmentioning

confidence: 99%

“…24 In our previous investigation, in which we used the FRAX score to predict fractures, TSH above the upper reference range was associated with lower femoral neck bone mineral density. 13 A study in 335 euthyroid Greek postmenopausal women has demonstrated that postmenopausal age and thyroid autoimmunity could predict a vertebral fracture in subjects with normal thyroid function. In this study, and several other investigations, the lower TSH was an independent risk factor for vertebral fractures, as were also antithyroid antibodies, although the levels of T3 and T4 within the reference range had no impact on fracture risk.…”

Section: Discussionmentioning

confidence: 99%

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The impact of thyroid autoimmunity (TPOAb) on bone density and fracture risk in postmenopausal women

Polovina

Miljić

Zivojinović³

et al. 2017

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ObJeCTIVe: Skeletal development, linear growth, cartilage biology and bone turnover are highly dependent on the activity of thyroid hormones. Thyroid dysfunction affects the skeleton, and autoimmune thyroid disease, manifesting as a chronic inflammatory condition, may be an important contributing factor to impaired bone quality in these patients. MATeRIAlS AND MeTHODS: Measurement of TSH, FT4, TPOAb and bone mineral density and FRAX score calculations were performed in 189 postmenopausal women (110 euthyroid women and 79 women diagnosed with subclinical hypothyroidism) divided into subgroups according to the presence of TPOAb. ReSUlTS: In multivariate logistic regression analysis only TPOAb were found to be significantly related to fracture, independently of TSH values (p=0.018; OR=7.800; 95% CI 1.424-42.721). Lower bone mineral density and FRAX score for hip and for major osteoporotic fractures were associated with the presence of TPOAb in euthyroid postmenopausal women in an unadjusted logistic regression model, as well as in a model adjusted for age, bMI and smoking. TSH was a better predictive factor for fractures in women with subclinical hypothyroidism (FRAX main p <0.001; 95% CI for SE 0.858-0.959 and FRAX hip p <0.001; 95% CI for SE 0.628-0.854). CONCLUSION: Autoimmune thyroid disease is associated with decreased bone mineral density at both spine and hip and risk of future fracture incidence in euthyroid postmenopausal women. Presence of TPOAb is a potential marker of higher fracture risk in these patients. However, in subclinical hypothyroidism, TSH is a better indicator of future fragility fractures than TPOAb.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The impact of thyroid autoimmunity (TPOAb) on bone density and fracture risk in postmenopausal women

Polovina

Miljić

Zivojinović³

et al. 2017

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“…Indeed, this algorithm is based on a finite number of variables, those considered most crucial in influencing FR [20]. However, it cannot consider all the factors involved in this process; indeed, hyperthyroidism itself [8] may be a risk factor, regardless of any other variable used to calculate the FRAX score. In this regard, it must be said that some new methods that include more factors, such as exercise and calcium intake (data not included in our study), are being studied.…”

Section: Considerations On Fraxmentioning

confidence: 99%

“…Bone mineral density (BMD) is one of the main factors predictive of fractures, but a number of independent risk factors may provide additional information on the 10-year FR (10-YFR) [8]. The WHO Collaborating Centre for Metabolic Bone Disease has recently ascertained that the 10-YFR can be estimated by means of the FR assessment tool (FRAX) score, which also includes clinical data and BMD measured by means of dual-energy X-ray absorptiometry (DXA) [8].…”

Section: Introductionmentioning

confidence: 99%

Ten-year estimated risk of bone fracture in women with differentiated thyroid cancer under TSH-suppressive levo-thyroxine therapy

Vera

Campomenosi

Paolino

et al. 2015

Endokrynologia Polska

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Introduction: After thyroidectomy and radioiodine therapy, patients with differentiated thyroid cancer (DTC) are indefinitely treated with levothyroxine (L-T4). Osteoporosis is a debated consequence of hypothyroxinaemia. The aim of this study was to evaluate bone mineral density (BMD) and fracture risk assessed by FRAX in a cohort of DTC women. Material and methods. Seventy-four women with DTC (aged 56.5 ± 9.9 years) treated at the mean age of 51.9 ± 12.0 years were studied. Baseline BMD and FRAX were evaluated after 3.0 years (median). BMD and FRAX were further evaluated 5.5 years (median) after the baseline evaluation. A cohort of 120 euthyroid women, matched for age, BMI, and menopausal status, were evaluated as controls. Results: L-T4 dosages were 813.6 ± 208.8 µg/week and 782.1 ± 184.4 µg/week at the baseline and second evaluation, respectively. The risks of major osteoporotic fracture (MOF) and hip fracture (HF) were similar in DTC patients and in controls. In DTC women, significant changes in FRAX were found, with a higher increase in the probability of HF than of MOF. A similar change was found in controls. A significant inverse correlation (P < 0.001) between L-T4 dosage and HF/MOF probability on both first and second evaluations was found. A significant inverse correlation (P = 0.05) was found between fT4, TSH and duration of therapy and HF/MOF probability only on the second evaluation. Conclusions: FRAX increase is a multi-factorial, age-related phenomenon. The absence of correlations between L-T4 dosage, length of therapy or fT4 levels and FRAX does not enable us to attribute an increased fracture risk to DTC women with well-controlled disease on therapy. (Endokrynol Pol 2016; 67 (4): 350-358)

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“…Existem algumas controvérsias quanto ao efeito direto do TSH na manutenção da massa óssea, e seu efeito indireto através da redução do metabolismo. Por um lado, os hormônios tireoidianos exercem efeitos catabólicos sobre o tecido ósseo; por outro lado, o hipotiroidismo está associado a aumento do risco de fraturas, mesmo em pacientes com doença subclínica 29 .…”

Section: Discussionunclassified

Alta Densidade Mineral Óssea: Dentro Da Normalidade Ou Mascarando a Fragilidade Óssea?

et al. 2015

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RESUMOObjetivo: O objetivo deste estudo foi avaliar indivíduos com alta DMO e correlacionar com parâmetros clínicos e laboratoriais. Métodos: Foi realizada uma pesquisa ao longo dos últimos 4 anos, nos arquivos da densitometria óssea do Departamento de Endocrinologia (Hospital de Clínicas da Universidade Federal do Paraná), em pacientes com Z-score ≥ 2,0 DP na coluna ou fêmur. Após a seleção, foram revisados os prontuários de cada paciente, avaliando sua história médica e comorbidades. Resultados: Foram selecionados 104 pacientes com idade média de 62 anos, sendo 96% da amostra do sexo feminino. O peso médio encontrado foi 70 kg e o índice de massa corporal foi 29 kg/m². Observou-se uma correlação estatisticamente significativa entre presença de artefatos e diagnóstico densitométrico anormal (p <0,001). Em pacientes com aumento da densidade óssea da coluna, aproximadamente 60% apresentavam osteopenia ou osteoporose em um ou mais locais, enquanto que em pacientes com artrose, 68% tiveram o diagnóstico de osteoporose ou osteopenia. Além disso, uma correlação significativa entre artefatos e Z-score ≥ 2,0 DP no colo do fêmur foi encontrada (p = 0,008). De todas as comorbidades analisadas, houve correlação entre hipertensão e presença de artefatos (p <0,001), como artrose e escoliose. Observou-se ainda que 72% dos pacientes com hipotireoidismo apresentaram artefatos (p = 0,014). Conclusão: Encontramos elevada prevalência de pacientes com alta massa óssea e diagnóstico final anormal na densitometria. Estes resultados mostram que a análise de um único sítio de densitometria pode conduzir ao diagnóstico incorreto, especialmente em pacientes com doença degenerativa.Palavras-Chave: Osteoporose, osteopenia, artefatos, alta densidade mineral óssea. ABSTRACTBackground: The aim of this study is to evaluate individuals with high BMD and correlate with clinical and laboratory parameters. Methods: We performed a search over the last 4 years, in the archives of bone densitometry of the Department of Endocrinology (Hospital de Clinicas, Federal University of Parana), in all patients with Z-score ≥ 2.0 SD in spine or femur. After selection, we reviewed the medical records of each patient, evaluating their comorbidities and medical history. Results: We selected 104 patients with mean age of 62 years, with 96% of the sample being women. The mean weight was 70 kg, and body mass index 29kg/m². A statistically significant correlation between the presence of artifacts and abnormal densitometric diagnosis (p <0.001) was observed.In patients with increased bone density in spine, approximately 60% had osteopenia or osteoporosis at one or more sites, whereas in patients with arthrosis, 68% had a diagnosis of osteoporosis or osteopenia. Furthermore, a significant correlation between artifacts and Z-score ≥ 2.0 SD in the femoral neck was found (p = 0.008). Of all comorbidities analyzed, there was correlation between hypertension and presence of artifacts (p <0.001), such as arthrosis and scoliosis. It was also observed that 72% of patients wit...

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Frax score calculations in postmenopausal women with subclinical hypothyroidism

Cited by 15 publications

References 55 publications

The impact of thyroid autoimmunity (TPOAb) on bone density and fracture risk in postmenopausal women

The impact of thyroid autoimmunity (TPOAb) on bone density and fracture risk in postmenopausal women

Ten-year estimated risk of bone fracture in women with differentiated thyroid cancer under TSH-suppressive levo-thyroxine therapy

Alta Densidade Mineral Óssea: Dentro Da Normalidade Ou Mascarando a Fragilidade Óssea?

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