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

Vera, Lara; Campomenosi, Claudia; Paolino, Sabrina; Pera, Giorgia; Monti, Eugenio; Mortara, Lorenzo; Seriolo, Bruno; Giusti, Massimo

doi:10.5603/ep.a2016.0046

Cited by 15 publications

(19 citation statements)

References 20 publications

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“…Five cross-sectional studies, involving a limited number of patients, have focused on the risk of fracture in patients with DTC treated with TSH suppressive therapy (67,68,69,70,71) (Table 2). Fujiyama et al evaluated 24 postmenopausal women treated with total thyroidectomy for DTC and found no difference in the incidence of vertebral deformity nor in the rate of bone loss between patients and 179 age-matched controls (67).…”

Section: Trabecular Bone Score (Tbs) and Quantitative Computed Tomogrmentioning

confidence: 99%

“…In the second study Reverter et al evaluated 33 men (mean age 56 ± 14 years) given TSH suppressive therapy with a median of 15 years and found no difference in the rate of either prevalent or incident (asymptomatic; 18.8 vs 16.7%) vertebral fractures between patients and 33 age-matched controls (69). In the third, Vera et al retrospectively evaluated the rate of prevalent and incident major osteoporotic fractures and hip fractures in 74 women (78% postmenopausal) with DTC with two or more BMD measurements and found no difference compared with a cohort of 120 euthyroid woman comparable for age, menopausal status and BMI, selected among patients evaluated for bone health (70). At variance with these studies, Mazziotti et al evaluated the incidence of radiological vertebral fractures in 179 consecutive women (median age 59 years, all but one postmenopausal) treated with total thyroidectomy for DTC attending to an outpatient endocrine clinic and evaluated for bone health (personal communication from the authors) (71).…”

Section: Trabecular Bone Score (Tbs) and Quantitative Computed Tomogrmentioning

confidence: 99%

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TSH suppressive therapy and bone

Brancatella

Marcocci

2020

Endocrine Connections

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Thyroid hormones stimulate bone turnover in adults by increasing osteoclastic bone resorption. TSH suppressive therapy is usually applied in patients with differentiated thyroid cancer (DTC) to improve the disease outcome. Over the last decades several authors have closely monitored the potential harm suffered by the skeletal system. Several studies and meta-analyses have shown that chronic TSH suppressive therapy is safe in premenopausal women and men. Conversely, in postmenopausal women TSH suppressive therapy is associated with a decrease of bone mineral density, deterioration of bone architecture (quantitative computed tomography, QCT; trabecular bone score, TBS), and, possibly, an increased risk of fractures. The TSH receptor is expressed in bone cells and the results of experimental studies in TSH receptor knockout mice and humans on whether low TSH levels, as opposed to solely high thyroid hormone levels, might contribute to bone loss in endogenous or exogenous thyrotoxicosis remain controversial. Recent guidelines on the use of TSH suppressive therapy in patients with DTC give value not only to its benefit on the outcome of the disease, but also to the risks associated with exogenous thyrotoxicosis, namely menopause, osteopenia or osteoporosis, age > 60 years, and history of atrial fibrillation. Bone health (BMD and/or preferably TBS) should be evaluated in postmenopausal women under chronic TSH suppressive therapy or in those patients planning to be treated for several years. Antiresorptive therapy could also be considered in selected cases (increased risk of fracture or significant decline of BMD/TBS during therapy) to prevent bone loss.

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Section: Trabecular Bone Score (Tbs) and Quantitative Computed Tomogrmentioning

confidence: 99%

Section: Trabecular Bone Score (Tbs) and Quantitative Computed Tomogrmentioning

confidence: 99%

TSH suppressive therapy and bone

Brancatella

Marcocci

2020

Endocrine Connections

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“…The remaining 8 studies fulfilling all inclusion criteria were reviewed (Table 1). [1011121314151617] Two was from Rochester, USA, 2 from Italy, 1 from Spain, 1 from Netherland, 1 from Japan, and 1 from Taiwan.…”

Section: Resultsmentioning

confidence: 99%

“…Vera et al[17] performed simulation study to compare BMD and fracture risk assessed by fracture risk assessment tool (FRAX) between 74 women with DTC (mean age, 51.9±12.0 years) and 120 euthyroid women, who were matched for age, BMI, and menopausal status, at baseline, 3 years and 5.5 years (median). The risks of major osteoporotic fracture and hip fracture were similar in DTC patients and in controls.…”

Section: Resultsmentioning

confidence: 99%

Risk of Osteoporotic Fractures after Thyroid-stimulating Hormone Suppression Therapy in Patients with Thyroid Cancer

et al. 2019

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Background: The effects of subclinical hyperthyroidism on fracture risk induced by thyroid-stimulating hormone (TSH) suppression therapy in patients with thyroid cancer still remains controversial. We performed a meta-analysis and systematic review to evaluate the effects of TSH suppression therapy on osteoporotic fracture in patients with thyroid cancer. Methods: We performed a systematic search to identify studies which included osteoporotic fractures (hip fracture and vertebral fracture) in patients on TSH suppression therapy for thyroid cancer. Main outcome measures were occurrence and risk of osteoporotic fractures including hip and vertebral fractures between patients and controls. Results: A systematic search yielded a total of 8 studies appropriate for review which included osteoporotic fracture outcome in patients on TSH suppression therapy for thyroid cancer. Studies with larger number of subjects showed the higher risk of osteoporotic fracture in group with TSH suppression therapy, although studies with smaller sample size presented a similar risk of fracture with control group. Conclusions: Although studies were limited by small numbers, results suggested possible association between chronic TSH suppression therapy and the increased risk of osteoporotic fractures in patients with thyroid cancer.

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“…Although several studies have been designed to explore the correlation between bone density changes and LT4 treatment, conflicting findings have been reported (4,5). Most of the reported studies have included small number of patients, and despite this limitation bone density seems to decrease in at least some DTC patients.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Predicting Osteoporosis in Patients Who Receive Thyrotropin Suppressive Levothyroxine Treatment for Differentiated Thyroid Carcinoma

Soydal¹,

Özkan²,

Nak³

et al. 2019

Mirt

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Objectives: Endogenous hyperthyroidism accelerates bone turnover and shortens the normal bone remodeling cycle, which results in reduced bone density. It is estimated that suppressive levothyroxine (LT4) therapy also decreases bone density. The aim of this study was to define risk factors for osteoporosis development in patients under thyrotropin-stimulating hormone (TSH) suppressive treatment for differentiated thyroid cancer (DTC). Methods: Patients with a diagnosis of low or intermediate risk group DTC according to the American Thyroid Association 2015 guidelines and who have been receiving LT4 suppression therapy and were physically fit to undergo femur and lumbar vertebra bone density study were included in the study. Patients lacking information on demographic data, medical history, preoperative thyroid hormone status, or routine follow-up data were excluded from the study. A study form consisting of patient information on possible risk factors for osteoporosis such as gender, age, menopausal status, smoking, family history of osteoporosis, preoperative thyroid hormone status, postoperative hypoparathyroidism history, mean serum TSH levels, and duration of TSH suppression was created and filled out for each participant. Bone mineral densitometries of the femur and lumbar vertebrae were measured along with serum vitamin D and parathyroid hormone levels. Results: During TSH suppression (mean 7.2±4.5 years, range: 1-26), osteoporosis was detected in 89 (9.6%) patients. The mean time to develop osteoporosis was significantly different in patients with or without a family history of osteoporosis (15.3±0.4 versus 20.3±0.6 years; p=0.002). Similarly, the mean time to develop osteoporosis for was found to be significantly shorter in postmenopausal patients than that for premenopausal women (18.6±0.7 versus 20.4±0.4 years; p<0.001). Male gender (p<0.001), a family history of osteoporosis (p=0.001) and menopausal state (p<0.001) were identified as independent predictive factors for developing osteoporosis. Conclusion: Postmenopausal women, men, and patients with a family history who receive TSH-suppression treatment have a tendency to develop osteoporosis.

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

Cited by 15 publications

References 20 publications

TSH suppressive therapy and bone

TSH suppressive therapy and bone

Risk of Osteoporotic Fractures after Thyroid-stimulating Hormone Suppression Therapy in Patients with Thyroid Cancer

Risk Factors for Predicting Osteoporosis in Patients Who Receive Thyrotropin Suppressive Levothyroxine Treatment for Differentiated Thyroid Carcinoma

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