The fracture risk assessment tool (FRAX® score) in subclinical hyperthyroidism

Polovina, Snežana; Micić, Dragan; Miljić, Dragana; Milić, Nataša; Mićić, Dragan; Popović, Vera

doi:10.2298/vsp1506510p

Cited by 9 publications

(11 citation statements)

References 42 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%

“…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. 7,21 On the other hand, a cross-sectional study with 37,431 subjects indicated that TSH within the euthyroid or subclinical hypothyroid range correlated with a higher BMD, though T3 in the upper tertile of the normal range had a negative impact on BMD, but not if T3 was lower. The authors speculated that the negative effect of T3 on the upper limit has been compensated for by an increase in TSH.…”

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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“…This includes a spectrum of cardiovascular risks, including atrial fibrillation and coronary heart disease morbidity and mortality (Collet et al 2012). There is also a documented association with dementia, decreased cognitive function (Annerbo & Lokk 2013) and osteoporosis (Biondi et al 2015, Polovina et al 2015.…”

Section: Risks Associated With Tsh Suppressionmentioning

confidence: 99%

WOMEN IN CANCER THEMATIC REVIEW: Thyroid-stimulating hormone in thyroid cancer: does it matter?

Nieto¹,

Boelaert²

2016

Endocrine-Related Cancer

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Differentiated thyroid cancer is the most common endocrine malignancy and the incidence is increasing rapidly worldwide. Appropriate diagnosis and post-treatment monitoring of patients with thyroid tumours are critical. Fine needle aspiration cytology remains the gold standard for diagnosing thyroid cancer, and although there have been significant refinements to this technique, diagnostic surgery is often required for patients suspected to have malignancy. Serum thyroid-stimulating hormone (TSH) is higher in patients with malignant thyroid nodules than in those with benign disease, and TSH is proportionally increased in more aggressive tumours. Importantly, we have shown that the pre-operative serum TSH concentration independently predicts the presence of malignancy in subjects presenting with thyroid nodules. Establishing the use of TSH measurements in algorithms identifying high-risk thyroid nodules in routine clinical practice represents an exciting, cost-efficient and non-invasive approach to optimise thyroid cancer diagnosis. Binding of TSH to receptors on thyrocytes stimulates a number of growth promoting pathways both in normal and malignant thyroid cells, and TSH suppression with high doses of levothyroxine is routinely used after thyroidectomy to prevent cancer recurrence, especially in high-risk tumours. This review examines the relationship between serum TSH and thyroid cancer and reflects on the clinical potential of TSH measurements in diagnosis and disease monitoring.

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“…In contrast, one study revealed a significant positive relationship between TSH level and the negative correlation between fT4 level and FN-BMD. This relationship was even evident after the adjustment of age, BMI and smoking [ 16 ]. Likewise, another study also found that hyperthyroidism was a significant risk factor for osteoporosis with the odds of developing osteoporosis being 2.89 with a high fT4 level.…”

Section: Reviewmentioning

confidence: 99%

Effect of Thyroxine and Thyrotropin on Bone Mineral Density in Postmenopausal Women: A Systematic Review

Poudel¹,

Chalasani²,

Goonathilake³

et al. 2022

Cureus

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The effect of thyroid hormones on bone mineral density in postmenopausal women has been reported but is not completely established. To better understand this relationship, this systematic review of the reported association, differences, and effects of thyroxine and/or thyrotropin levels on bone mineral density was conducted. An electronic literature search was conducted on MEDLINE, PMC, Google Scholar, Cochrane Library, and Science Direct from inception to April 2022; 20 studies were identified which include five quasiexperimental studies, three community cohort studies, and 12 hospital-based cross-sectional studies. Following an extensive evaluation, it was difficult to conclusively determine the association or effect of thyroxine or thyrotropin levels on bone mineral density in postmenopausal women. It is therefore suggested to conduct additional non-randomized or randomized control studies on this topic for the benefit of postmenopausal women. Particular attention should be given to the adjustment of age, body mass index, smoking status, alcohol consumption, and dietary calcium in future research on this topic for rigorous analysis.

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The fracture risk assessment tool (FRAX® score) in subclinical hyperthyroidism

Cited by 9 publications

References 42 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

WOMEN IN CANCER THEMATIC REVIEW: Thyroid-stimulating hormone in thyroid cancer: does it matter?

Effect of Thyroxine and Thyrotropin on Bone Mineral Density in Postmenopausal Women: A Systematic Review

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