Risk of Osteoporosis and Fractures in Patients with Thyroid Cancer: A Case-Control Study in U.S. Veterans

Abstract

Background Data on osteoporosis and fractures in patients with thyroid cancer, especially men, are conflicting. Our objective was to determine osteoporosis and fracture risk in U.S. veterans with thyroid cancer. Materials and Methods This is a case‐control study using the Veterans Health Administration Corporate Data Warehouse (2004–2013). Patients with thyroid cancer (n = 10,370) and controls (n = 10,370) were matched by age, sex, weight, and steroid use. Generalized linear mixed‐effects regression model was used to compare the two groups in terms of osteoporosis and fracture risk. Next, subgroup analysis of the patients with thyroid cancer using longitudinal thyroid‐stimulating hormone (TSH) was performed to determine its effect on risk of osteoporosis and fractures. Other covariates included patient age, sex, median household income, comorbidities, and steroid and androgen use. Results Compared with controls, osteoporosis, but not fractures, was more frequent in patients with thyroid cancer (7.3% vs. 5.3%; odds ratio [OR], 1.33; 95% confidence interval [CI], 1.18–1.49) when controlling for median household income, Charlson/Deyo comorbidity score, and androgen use. Subgroup analysis of patients with thyroid cancer demonstrated that lower TSH (OR, 0.93; 95% CI, 0.90–0.97), female sex (OR, 4.24; 95% CI, 3.53–5.10), older age (e.g., ≥85 years: OR, 17.18; 95% CI, 11.12–26.54 compared with <50 years), and androgen use (OR, 1.63; 95% CI, 1.18–2.23) were associated with osteoporosis. Serum TSH was not associated with fractures (OR, 1.01; 95% CI, 0.96–1.07). Conclusion Osteoporosis, but not fractures, was more common in U.S. veterans with thyroid cancer than controls. Multiple factors may be contributory, with low TSH playing a small role. Implications for Practice Data on osteoporosis and fragility fractures in patients with thyroid cancer, especially in men, are limited and conflicting. Because of excellent survival rates, the number of thyroid cancer survivors is growing and more individuals may experience long‐term effects from the cancer itself and its treatments, such as osteoporosis and fractures. The present study offers unique insight on the risk for osteoporosis and fractures in a largely male thyroid cancer cohort. Physicians who participate in the long‐term care of patients with thyroid cancer should take into consideration a variety of factors in addition to TSH level when considering risk for osteoporosis.

Thyroid Nodule Evaluation and Management in Older Adults: A Review of Practical Considerations for Clinical Endocrinologists

“…63 Furthermore, several studies have shown that older adults, especially those with comorbidities, are more vulnerable to complications from thyroid cancer treatment, including surgical complications, as well as cardiovascular and skeletal adverse effects from subsequent TSH suppression therapy. 14, [64][65][66][67][68][69] These studies collectively provide further guidance in carefully balancing benefits and risks to tailor treatment to the patient. Even though it is generally acknowledged that the potential benefits outweigh the risks for surgery for clinically relevant thyroid cancers that are >1 cm with better outcomes if referred to high-volume surgeons, 12,70-75 recent evidence supports that surveillance may be a safe alternative in those with small nodules resulting in indeterminate cytology, papillary microcarcinomas or patients with limited lifespan.…”

MicroRNA-197-3p Inhibits the Osteogenic Differentiation in Osteoporosis by Down-Regulating KLF 10

“…Osteoporosis is a public health problem with about 200 million patients worldwide. 1 Among women over 60 in China, the prevalence of osteoporosis is as high as 40% −50%, of which about 30% −50% experience osteoporosis-related fractures. 2 It seriously affects the physical health and life quality, and even lead to shortened life span.…”

Analyses of the Association between Thyroid Cancer and Osteoporosis/Fracture Histories: A Cross-Sectional Study Using KoGES HEXA Data

“…Previous studies have suggested that the incidence of osteoporosis is higher in patients with than in those without thyroid cancer [ 8 , 9 , 10 , 11 ]. In a population-based observational cohort study in Taiwan, the total thyroidectomy group showed a significantly elevated long-term risk of osteoporosis [ 12 ].…”

“…Some studies have suggested that the risk of fracture is significantly increased in thyroid cancer patients [ 13 , 14 ]. However, other studies have suggested that the risk of fracture is not higher in thyroid cancer or total thyroidectomy patients than in patients who have not undergone thyroidectomy [ 9 , 12 ]. Moreover, patients with TSH suppression therapy but not those with thyroid cancer experience a high number of fractures [ 15 , 16 , 17 ].…”