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Hip bone mineral density, bone turnover and risk of fracture in patients on long-term suppressive L-thyroxine therapy for differentiated thyroid carcinoma

¹ Department of Internal Medicine, Division of Endocrinology, University Hospital Maastricht, Maastricht, The Netherlands, ² Department of Internal Medicine, Hospital Bernhoven, Veghel/Oss, The Netherlands, ³ Department of Psychology and Health, Tilburg University and St Elisabeth Hospital Tilburg, Tilburg, The Netherlands ⁴ Department of Clinical Chemistry, University Hospital Maastricht, Maastricht, The Netherlands and ⁵ Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands

(Correspondence should be addressed to A C Heijckmann; Email: c.heijckmann{at}bernhoven.nl)

Objective: Untreated hyperthyroidism and treatment with high doses of thyroid hormone are associated with osteoporosis. However, their effect on bone turnover, their contribution to bone mineral density (BMD) in the context of other clinical risk factors for osteoporosis and the prevalence of vertebral fractures is not well documented.

Design: Cross-sectional study.

Methods: We studied 59 patients receiving L-thyroxine suppressive therapy for differentiated thyroid carcinoma (DTC). BMD of the hip was measured by dual X-ray absorptiometry (DXA) and lateral DXA pictures of the lumbar and thoracic vertebrae were performed. Bone resorption was measured by C-telopeptides of type I collagen (ICTP) and bone formation by procollagen type I N-propeptide (PINP). Clinical risk factors for osteoporosis were evaluated using a questionnaire.

Results: Z-scores of BMD were similar as the NHANES (National Health and Nutrition Examination Survey) III reference group in women and men, also after long-term (>10 years) suppression therapy. Patients in the lowest and highest quartile of BMD showed significant differences in the presence of clinical risk factors. ICTP levels were significantly higher than in age-matched controls, PINP levels were not different. We found four patients with a prevalent vertebral fracture.

Conclusions: We conclude that patients with well-differentiated thyroid carcinoma are not at increased risk of developing low bone mass nor have a higher prevalence of vertebral fracture at least when treated with relatively low doses of L-thyroxine.

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