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Influence of Hyper- and Hypothyroidism, and the Effects of Treatment with Antithyroid Drugs and Levothyroxine on Fracture Risk

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Abstract

The purpose of this study was to assess alterations in fracture risk in patients with hyper- and hypothyroidism, and the effects of antithyroid drugs and levothyroxine on fracture risk. The study was designed as a case–control study. All patients with a fracture (n = 124,655) in the year 2000 in Denmark served as cases. For each case, three age- and gender-matched controls were randomly drawn from the general population (n = 373,962). Exposure variables were a diagnosis of hyperthyroidism, hypothyroidism, ever use of antithyroid drugs, and ever use of levothyroxine. Adjustments were made for time since diagnosis, surgery for hyperthyroidism, thyroid cancer, prior fracture, alcoholism, and corticosteroid use. There was an increase in the risk of any fracture within the first 5 years after a diagnosis of hyperthyroidism, and the first 10 years after a diagnosis of hypothyroidism. Use of antithyroid drugs was associated with a significantly reduced fracture risk independently of the dose used (odds ratio [OR] 0.79–0.84, 2P < 0.05). No effect of levothyroxine on fracture risk was present. Thyroid surgery for hyperthyroidism and thyroid cancer were not associated with fracture risk. A prior fracture, alcoholism, and corticosteroid use were significant risk factors for fractures. Fracture risk is increased at the time of diagnosis of both hyper- and hypothyroidism, and this increase seems reversible. Low-dose levothyroxine was not associated with fracture risk. The effect of antithyroid drugs may be caused by the reduction in thyroid hormone levels.

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References

  1. Eriksen EF, Mosekilde L, Melsen F (1985) Trabecular bone remodeling and bone balance in hyperthyroidism. Bone 6:421–428

    Article  PubMed  Google Scholar 

  2. Mosekilde L, Melsen F, Bagger JP, et al. (1977) Bone changes in hyperthyroidism: interrelationships between bone histomorphometry, thyroid function and calcium-phosphorus metabolism. Acta Endocrinol 85:515–525

    PubMed  Google Scholar 

  3. Ross DS (1994) Hyperthyroidism, thyroid hormone therapy, and bone. Thyroid 4:319–326

    PubMed  Google Scholar 

  4. Mosekilde L, Eriksen EF, Charles P (1990) Effects of thyroid hormones on bone and mineral metabolism. Endocrinol Metab Clin North Am 19:35–63

    PubMed  Google Scholar 

  5. Vestergaard P, Mosekilde L (2003) Hyperthyroidism, bone mineral, and fracture risk—a meta-analysis. Thyroid 13:585–593

    Article  PubMed  Google Scholar 

  6. Coindre JM, David JP, Riviere I, et al. (1986) Bone loss in hypothyroidism with hormone replacement. A histomorphometric study. Arch Intern Med 146:48–53

    Article  PubMed  Google Scholar 

  7. Mosekilde L, Melsen F (1978) Morphometric and dynamic studies of bone changes in hypothyroidism. Acta Pathol Microbiol Scand [A] 86:56–62

    Google Scholar 

  8. Abu EO, Bord S, Horner A, et al. (1997) The expression of thyroid hormone receptors in human bone. Bone 21:137–142

    Article  PubMed  Google Scholar 

  9. Mazziott G, Sorvillo F, Piscopo M, et al. (2005) Recombinant human TSH modulates in vivo C-telopeptides of type- 1 collagen and bone alkaline phosphatase, but not osteoprotegerin production in postmenopausal women monitored for differentiated thyroid carcinoma. J Bone Miner Res 20:480–486

    PubMed  Google Scholar 

  10. Ribot C, Tremollieres F, Pouilles JM, et al. (1990) Bone mineral density and thyroid hormone therapy. Clin Endocrinol (Oxf) 33:143–153

    Google Scholar 

  11. Trémollières F, Pouillès JM, Louvet JP, et al. (1991) [Transitory bone loss during substitution treatment for hypothyroidism. Results of a two year prospective study. Rev Rhum Mal Osteoartic 58:869–875 [French]

    PubMed  Google Scholar 

  12. Vestergaard P, Weeke J, Hoeck HG, et al. (2000) Fractures in patients with primary idiopathic hypothyroidism. Thyroid 10:335–340

    PubMed  Google Scholar 

  13. Uzzan B, Campos J, Cucherat M, et al. (1996) Effects on bone mass of long term treatment with thyroid hormones: a meta-analysis. J Clin Endocrinol Metab 81:4278–4289

    Article  PubMed  Google Scholar 

  14. Vestergaard P, Rejnmark L, Weeke J, et al. (2000) Fracture risk in patients treated for hyperthyroidism. Thyroid 10:341–348

    PubMed  Google Scholar 

  15. Mosekilde L, Melsen F (1978) Effect of antithyroid treatment on calcium-phosphorus metabolism in hyperthyroidism. II: bone histomorphometry. Acta Endocrinol (Copenh) 87:751–758

    Google Scholar 

  16. Mosekilde L, Christensen MS, Melsen F, et al. (1978) Effect of antithyroid treatment on calcium-phosphorus metabolism in hyperthyroidism. I: chemical quantities in serum and urine. Acta Endocrinol (Copenh) 87:743–750

    Google Scholar 

  17. Jodar E, Munoz-Torres M, Escobar-Jimenez F, et al. (1997) Antiresorptive therapy in hyperthyroid patients: longitudinal changes in bone and mineral metabolism. J Clin Endocrinol Metab 82:1989–1994

    Article  PubMed  Google Scholar 

  18. Faber J, Jensen IW, Petersen L, et al. (1998) Normalization of serum thyrotropin by means of radioiodine treatment in subclinical hyperthyroidism: effect on bone loss in postmenopausal women. Clin Endocrinol (Oxf) 48:285–290

    Article  Google Scholar 

  19. Wacholder S, McLaughlin JK, Silverman DT, et al. (1992) Selection of controls in case-control studies. I. Principles. Am J Epidemiol 135:1019–1028

    Google Scholar 

  20. Vestergaard P, Emborg C, Støving RK, et al. (2002) Fractures in patients with anorexia nervosa, bulimia nervosa, and other eating disorders—a nation-wide register study. Int J Eating Disord 32:301–308

    Article  Google Scholar 

  21. Klotzbuecher CM, Ross PD, Landsman PB, et al. (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the litterature and statistical synthesis. J Bone Miner Res 15:721–739

    PubMed  Google Scholar 

  22. Kanis JA, Johansson H, Johnell Q, et al. (2005) Alcohol intake as a risk factor for fracture. Osteoporos Int 16: 737–742

    Article  PubMed  Google Scholar 

  23. Andergen TF, Madsen M, Jørgensen J, et al. (1999) The Danish National Hospital Register. Dan Med Bull 46:263–268

    PubMed  Google Scholar 

  24. Munk-Jørgensen P, Mortensen PB (1997) The Danish Psychiatric Central Register. Dan Med Bull 44:82–84

    PubMed  Google Scholar 

  25. Mosbech J, Jørgensen J, Madsen M, et al. (1995) [The Danish National Patient Register: evaluation of data quality. Ugeskr Lasger 157:3741–3745 [Danish]

    Google Scholar 

  26. Vestergaard P, Mosekilde L (2002) Fracture risk in patients with celiac disease, Crohn’s disease, and ulcerative colitis: a nation-wide follow-up study in 16,416 patients in Denmark. Am J Epidemiol 156:1–10

    Article  PubMed  Google Scholar 

  27. Larsen ER, Mosekilde L, Foldspang A (2004) Correlates of falling during 24 h among elderly Danish community residents. Prev Med 39:389–398

    Article  PubMed  Google Scholar 

  28. Schwartz AV, Villa ML, Prill M, et al. (1999). Falls in older Mexican-American women. J Am Geriatr Soc 47:1371–1378

    PubMed  Google Scholar 

  29. Vestergaard P, Rejnmark L, Weeke J, et al. (2002) Smoking as a risk factor for Graves’ disease, toxic nodular goitre, and primary idiopathic hypothyroidism. Thyroid 12:69–75

    Article  PubMed  Google Scholar 

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Acknowledgement

The National Bureau of Statistics (Statistics Denmark) is acknowledged for their help, without which this project would not have been possible.

Financial support was provided by the Danish Medical Research Council (Grant number 22-04-0495).

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism C, Aarhus University Hospital, Aarhus Sygehus, Tage Hansens Gade 2, Aarhus, Denmark

    P. Vestergaard, L. Rejnmark & L. Mosekilde

  2. The Osteoporosis Clinic, Aarhus Sygehus Tage Hansens Gade 2 DK-8000, Aarhus C, Denmark

    P. Vestergaard

Authors
  1. P. Vestergaard
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  2. L. Rejnmark
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  3. L. Mosekilde
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Correspondence to P. Vestergaard.

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Vestergaard, P., Rejnmark, L. & Mosekilde, L. Influence of Hyper- and Hypothyroidism, and the Effects of Treatment with Antithyroid Drugs and Levothyroxine on Fracture Risk. Calcif Tissue Int 77, 139–144 (2005). https://doi.org/10.1007/s00223-005-0068-x

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  • DOI: https://doi.org/10.1007/s00223-005-0068-x

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