open access

Vol 67, No 4 (2016)
Original papers
Published online: 2016-07-05
Submitted: 2015-11-10
Accepted: 2016-04-05
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Ten-year estimated risk of bone fracture in women with differentiated thyroid cancer under TSH-suppressive levothyroxine therapy

Lara Vera, Stefano Gay, Claudia Campomenosi, Sabrina Paolino, Giorgia Pera, Eleonora Monti, Lorenzo Mortara, Bruno Seriolo, Massimo Giusti
DOI: 10.5603/EP.a2016.0046
·
Endokrynologia Polska 2016;67(4):350-358.

open access

Vol 67, No 4 (2016)
Original papers
Published online: 2016-07-05
Submitted: 2015-11-10
Accepted: 2016-04-05

Abstract

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)

Abstract

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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Keywords

bone fracture risk; osteoporosis; FRAX; thyroid cancer; levo-thyroxine therapy; hyperthyroxinemia

About this article
Title

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

Journal

Endokrynologia Polska

Issue

Vol 67, No 4 (2016)

Pages

350-358

Published online

2016-07-05

DOI

10.5603/EP.a2016.0046

Bibliographic record

Endokrynologia Polska 2016;67(4):350-358.

Keywords

bone fracture risk
osteoporosis
FRAX
thyroid cancer
levo-thyroxine therapy
hyperthyroxinemia

Authors

Lara Vera
Stefano Gay
Claudia Campomenosi
Sabrina Paolino
Giorgia Pera
Eleonora Monti
Lorenzo Mortara
Bruno Seriolo
Massimo Giusti

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