Prospective study of bone loss in pre‐ and post‐menopausal women on <scp>L</scp>‐thyroxine therapy for non‐toxic goitre

Rosa, Gennaro De; Testa, Americo; Giacomini, Damiana; Carrozza, Cinzia; Astazi, P.; Caradonna, Paolo

doi:10.1046/j.1365-2265.1997.3221125.x

Cited by 30 publications

(31 citation statements)

References 19 publications

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“…Glucocorticoid replacement was independently associated with reduced BMD at the femoral neck and lumber spine and an increased frequency of osteopenia in women with ACTH insufficiency [11]. In primary hypothyroidism patients, supraphysiological doses of L-thyroxine decreased BMD at the femoral neck and lumber spine [12]. These previous findings suggest that hormone replacement for hypoadrenalism and hypothyroidism may reduce BMD.…”

Section: Baseline Bmd Measurementsmentioning

confidence: 74%

Postoperative changes in bone metabolism and bone mineral density in Japanese patients with acromegaly: a 3-year prospective study

et al. 2015

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GROWTH HORMONE (GH) and insulin-like growth factor-I (IGF-I) are anabolic hormones for bone with important regulating effects on bone metabolism not only in childhood, but also in adulthood [1]. In active acromegaly, GH excess increases bone turnover, which is characterized predominantly by bone formation, resulting in an overall increase in BMD [2-4], although aging, sex, and hypogonadism in such patients is usually correlated with decreased BMD [3][4][5]. Although BMD in acromegalic patients should decrease after the treatment of transsphenoidal surgery (TSS), our previous study showed a rapid decline in bone turnover markers but not BMD in acromegalic patients at firstPostoperative changes in bone metabolism and bone mineral density in Japanese patients with acromegaly: a 3-year prospective study Abstract. Growth hormone and insulin-like growth factor-I play important roles in regulating bone metabolism and bone mineral density in adulthood. However, the effect of excess growth hormone on bone metabolism and bone mineral density is not fully understood. Here, we investigated the long-term changes in bone metabolism and bone mineral density after a rapid decline in growth hormone levels due to transsphenoidal surgery in acromegalic patients. Eighteen acromegalic patients (10 males and 8 females) who underwent transsphenoidal surgery were enrolled in this prospective study. Bone formation marker (serum bone alkaline phosphatase), bone resorption marker (urinary type I collagen cross-linked N-telopeptide), and bone mineral density were measured before surgery and at 3 months, 1 year, and 3 years after transsphenoidal surgery. While both serum bone alkaline phosphatase and urinary type I collagen cross-linked N-telopeptide levels decreased significantly after surgery, serum bone alkaline phosphatase / urinary type I collagen cross-linked N-telopeptide ratio was significantly increased at 3 months and 3 years after surgery. Bone mineral density did not change markedly after surgery. In conclusion, the rapid decline in growth hormone levels following transsphenoidal surgery had no marked effect on bone mineral density for up to 3 years, despite significant changes in levels of bone turnover makers post-surgery.

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Section: Baseline Bmd Measurementsmentioning

confidence: 74%

Postoperative changes in bone metabolism and bone mineral density in Japanese patients with acromegaly: a 3-year prospective study

et al. 2015

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“…Kung & Pun (20) and Paul et al (11) found that BMD at the spine was unaffected, but that BMD at the femur was reduced by 5-10% with long-term treatment. De Rosa et al (45) showed a significant postmenopausal reduction in BMD at the spine (-1.3%) and femoral neck (-1.5%) in a 1 year prospective study of women with subnormal but not suppressed serum TSH values and controls. Our results also tended to show that suppressive L-T 4 treatment had a greater effect on postmenopausal than premenopausal women, even after controlling for confounding factors, but in both groups the effect on QUS variables was small.…”

Section: Discussionmentioning

confidence: 96%

“…Several studies showed a reduction in BMD (13, 45,46), but the meta-analyses by Faber & Galloe (47) and by Wü ster (9) found no significant BMD reduction associated with suppressive treatment in premenopausal women. Marcocci et al (48) examined BMD and biochemical markers of bone turnover in 47 premenopausal women treated for more than 5 years where TSH was monitored to minimise the L-T 4 dose.…”

Section: Discussionmentioning

confidence: 99%

The effect of long-term, non-suppressive levothyroxine treatment on quantitative ultrasonometry of bone in women

Hadji

Hars²,

Sturm³

et al. 2000

European Journal of Endocrinology

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Objective: To evaluate the impact of long-term, non-suppressive levothyroxine (L-T 4 ) treatment on quantitative ultrasonometry in women.Design: This was a case-control study. Subjects and methods: Altogether 667 women (mean age Ϯ S.D., 49.5 Ϯ 13.1 years) were studied. Of these, 156 (23%) had non-toxic goitre or hypothyroidism and had been taking L-T 4 (75-100 mg/day) for at least 5 years (mean Ϯ S.D., 12.5 Ϯ 7.5 years); the remaining 511 (77%) women were not receiving L-T 4 . All women had completed a questionnaire on risk factors for thyroid dysfunction and osteoporosis, and those with diseases or treatments known to effect bone metabolism -other than thyroxine or hormone replacement therapy (HRT) -were excluded. Women underwent quantitative ultrasonometry (QUS) at the heel. Speed of sound (SOS), broadband ultrasound attenuation (BUA) and the stiffness index (SI) were compared, first, in all women taking L-T 4 and controls and, secondly, in women taking L-T 4 and controls pair-matched for age, weight, body mass index (BMI), menopausal status and HRT use. Results: Even after matching for age, weight, BMI, menopausal and HRT status, women taking L-T 4 had significantly lower values for SOS and SI (P < 0.05), but not for BUA. However, absolute T-and Z-scores for SI were not low in either the study or control groups. Lower values were associated, but not significantly so, with years since the menopause and duration of L-T 4 treatment. Conclusions: Long-term, non-suppressive L-T 4 treatment in women with goitre or hypothyroidism was associated with a slight reduction in QUS values, which was more pronounced in postmenopausal women. This group could be at higher risk for osteoporotic fracture.

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“…The lack of ultrasensitive thyroid-stimulating hormone (TSH) assay and densitometers with adequate precision and the heterogeneity of study protocols and analyzed series could explain these discordant results [1,2,3,4,5,6,7]. …”

Section: Introductionmentioning

confidence: 99%

Effects on Bone Mineral Density by Treatment of Benign Nodular Goiter with Mildly Suppressive Doses of <i>L</i>-Thyroxine in a Cohort Women Study

Appetecchia

2005

Horm Res Paediatr

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Objectives: Thyroid diseases and their treatment may influence the osseous system. The influence that prolonged suppressive L-thyroxine (LT4) therapy may have on inducing subclinical hyperthyroidism on bone metabolism is still a matter of debate. The aim of the present study was to assess the effects of chronic LT4 treatment at mildly inhibiting serum thyroid-stimulating hormone (TSH) doses on bone mineral density (BMD) and biochemical bone remodeling markers in a cohort of women with benign nodular goiter, and to verify the efficacy of the treatment on nodule size. Subjects and Study Design: A total of 200 euthyroid Caucasian women with nodular goiter (age 52.1 ± 9; 80 pre- and 120 postmenopausal) were enrolled: 96 had been treated with LT4 for at least 3 years and a matched group of 104 had untreated goiter. LT4 therapy was given at a dose sufficient to reduce TSH under the lower limit of the normal range (0.27–4.20 µIU/ml) without suppressing it below the limit of assay sensitivity (0.005 µIU/ml) and maintaining normal serum values of free triiodothyronine (FT3) and free thyroxine (FT4). The adequacy of the dose was evaluated on the basis of serum TSH levels. The osteopenic effect of LT4 treatment was evaluated directly by total body and lumbar spine dual-energy X-ray absorptiometry (DEXA) and indirectly by biochemical parameters (alkaline phosphatase, osteocalcin, calcium, parathyroid hormone) at the baseline and throughout the follow-up. The efficacy of LT4 schedule on thyroid nodule size was assessed on the basis of the ultrasonographic evaluation. Results: Mineralometric data showed no significant difference between BMD values for treated and untreated patients in both pre- and postmenopausal status. In all patients, serum markers of bone turnover were in the normal range, with no differences in the treated and control groups. The TSH concentrations were significantly lower in treated than in untreated patients (p < 0.0001); FT3 and FT4 were in the normal range for all patients. Evaluation of nodule size during follow-up showed a reduction of ≧30% in 32 of 96 treated patients (33.3%) versus none in those untreated, whilst nodule size remained unmodified in 60 treated patients (62.5%) versus 35 (33.6%) in those untreated, and an increase in nodule size and/or development of new nodules was found in 4 treated patients (4.2%) versus 69 of the 104 untreated patients (66.3%). Conclusions: This study suggests that at slightly suppressing TSH doses, LT4 therapy has no adverse effects on BMD in both pre- and postmenopausal women, while having an efficacy on nodule size comparable with that reported using an LT4 schedule able to maintain TSH near or below the assay sensitivity limit.

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Prospective study of bone loss in pre‐ and post‐menopausal women on L‐thyroxine therapy for non‐toxic goitre

Abstract: This longitudinal study suggests that TSH-suppressive therapy with L-thyroxine for non-toxic goitre significantly increases the bone mineral turnover and might contribute to a BMD reduction, more marked on cortical bone, in both pre- and post-menopausal women.

Cited by 30 publications

References 19 publications

Postoperative changes in bone metabolism and bone mineral density in Japanese patients with acromegaly: a 3-year prospective study

Postoperative changes in bone metabolism and bone mineral density in Japanese patients with acromegaly: a 3-year prospective study

The effect of long-term, non-suppressive levothyroxine treatment on quantitative ultrasonometry of bone in women

Effects on Bone Mineral Density by Treatment of Benign Nodular Goiter with Mildly Suppressive Doses of <i>L</i>-Thyroxine in a Cohort Women Study

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