Measurements of Bone Health After Thyroid-Stimulating Suppression Therapy in Postmenopausal Women with Differentiated Thyroid Carcinoma: Bone Mineral Density Versus the Trabecular Bone Score

Overview

Journal J Clin Med

Specialty General Medicine

Date 2021 Jun 2

PMID 34063726

Citations 3

Authors

Chae Won Chung

Hoon Sung Choi

Sung Hye Kong

Young Joo Park

Do Joon Park

Hwa Young Ahn

Sun Wook Cho

Affiliations

Soon will be listed here.

Abstract

Background: Thyroid-stimulating hormone (TSH) suppression therapy is an important treatment modality for differentiated thyroid carcinoma (DTC), but it increases fracture risk. The aim of this study was to evaluate changes in bone mineral density (BMD) and trabecular bone score (TBS) in postmenopausal DTC patients receiving TSH suppression therapy.

Methods: A total of 410 postmenopausal DTC patients who underwent thyroidectomy and had at least two dual-energy X-ray absorptiometry measurements, including a preoperative measurement, were included. Patients who had osteoporosis medication for more than 1 year were classified as 'patients with osteoporosis'.

Results: In patients without osteoporosis, the change in %BMD was similar between TSH suppression (-) and (+) groups, while the decrease in %TBS was significantly greater in the TSH suppression (+) group than that of the TSH suppression (-) group. The relative risk of vertebral fracture was decreased by TBS changes but not by BMD changes. In patients with osteoporosis, both BMD and TBS showed significant increases in the TSH suppression (-) group but not in TSH suppression (+) group. At year 4, TBS was significantly lower in the TSH suppression (+) group than that in the TSH suppression (-) group, while BMD showed no difference between groups.

Conclusions: TBS may better reflect bone health than BMD in postmenopausal DTC patients with TSH suppression therapy.

Citing Articles

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References

Mazzaferri E, Young R, OERTEL J, KEMMERER W, Page C . Papillary thyroid carcinoma: the impact of therapy in 576 patients. Medicine (Baltimore). 1977; 56(3):171-96. View

Shah V, Sippl R, Joshee P, Pyle L, Kohrt W, Schauer I . Trabecular bone quality is lower in adults with type 1 diabetes and is negatively associated with insulin resistance. Osteoporos Int. 2018; 29(3):733-739. PMC: 5841462. DOI: 10.1007/s00198-017-4353-0. View

Wang L, Smith A, Palmer F, Tuttle R, Mahrous A, Nixon I . Thyrotropin suppression increases the risk of osteoporosis without decreasing recurrence in ATA low- and intermediate-risk patients with differentiated thyroid carcinoma. Thyroid. 2014; 25(3):300-7. PMC: 6916125. DOI: 10.1089/thy.2014.0287. View

Amnuaywattakorn S, Sritara C, Utamakul C, Chamroonrat W, Kositwattanarerk A, Thamnirat K . Simulated increased soft tissue thickness artefactually decreases trabecular bone score: a phantom study. BMC Musculoskelet Disord. 2016; 17:17. PMC: 4710977. DOI: 10.1186/s12891-016-0886-1. View

Mosekilde L, Melsen F, Christensen M . Interrelationships between bone morphometry, thyroid function tests and serum parathyroid hormone in hyperthyroidism. Calcif Tissue Res. 1977; 22 Suppl:229-35. DOI: 10.1007/BF02064070. View

Leslie W, Majumdar S, Morin S, Hans D, Lix L . Change in Trabecular Bone Score (TBS) With Antiresorptive Therapy Does Not Predict Fracture in Women: The Manitoba BMD Cohort. J Bone Miner Res. 2016; 32(3):618-623. DOI: 10.1002/jbmr.3054. View

Mazzetti G, Berger C, Leslie W, Hans D, Langsetmo L, Hanley D . Densitometer-Specific Differences in the Correlation Between Body Mass Index and Lumbar Spine Trabecular Bone Score. J Clin Densitom. 2016; 20(2):233-238. DOI: 10.1016/j.jocd.2016.11.003. View

Choi H, Lim J, Ahn H, Cho S, Lee K, Kim K . Secular trends in the prognostic factors for papillary thyroid cancer. Eur J Endocrinol. 2014; 171(5):667-75. DOI: 10.1530/EJE-14-0225. View

De Mingo Dominguez M, Guadalix Iglesias S, Arroba C, Lopez Alvarez B, Diaz-Guerra G, Martinez-Pueyo J . Low trabecular bone score in postmenopausal women with differentiated thyroid carcinoma after long-term TSH suppressive therapy. Endocrine. 2018; 62(1):166-173. DOI: 10.1007/s12020-018-1671-8. View

10.

Schuit S, van der Klift M, Weel A, de Laet C, Burger H, Seeman E . Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. 2004; 34(1):195-202. DOI: 10.1016/j.bone.2003.10.001. View

11.

Kim C, Hong S, Oh S, Lee J, Han J, Hong S . Change of Bone Mineral Density and Biochemical Markers of Bone Turnover in Patients on Suppressive Levothyroxine Therapy for Differentiated Thyroid Carcinoma. J Bone Metab. 2015; 22(3):135-41. PMC: 4572035. DOI: 10.11005/jbm.2015.22.3.135. View

12.

Hong A, Kim J, Kim S, Kim S, Shin C . Trabecular bone score as a skeletal fragility index in acromegaly patients. Osteoporos Int. 2015; 27(3):1123-1129. DOI: 10.1007/s00198-015-3344-2. View

13.

Flynn R, Bonellie S, Jung R, MacDonald T, Morris A, Leese G . Serum thyroid-stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy. J Clin Endocrinol Metab. 2009; 95(1):186-93. DOI: 10.1210/jc.2009-1625. View

14.

Mazziotti G, Biagioli E, Maffezzoni F, Spinello M, Serra V, Maroldi R . Bone turnover, bone mineral density, and fracture risk in acromegaly: a meta-analysis. J Clin Endocrinol Metab. 2014; 100(2):384-94. DOI: 10.1210/jc.2014-2937. View

15.

Pothuaud L, Carceller P, Hans D . Correlations between grey-level variations in 2D projection images (TBS) and 3D microarchitecture: applications in the study of human trabecular bone microarchitecture. Bone. 2008; 42(4):775-87. DOI: 10.1016/j.bone.2007.11.018. View

16.

Winzenrieth R, Michelet F, Hans D . Three-dimensional (3D) microarchitecture correlations with 2D projection image gray-level variations assessed by trabecular bone score using high-resolution computed tomographic acquisitions: effects of resolution and noise. J Clin Densitom. 2012; 16(3):287-296. DOI: 10.1016/j.jocd.2012.05.001. View

17.

Moon J, Kim K, Oh T, Choi S, Lim S, Park Y . The Effect of TSH Suppression on Vertebral Trabecular Bone Scores in Patients With Differentiated Thyroid Carcinoma. J Clin Endocrinol Metab. 2016; 102(1):78-85. DOI: 10.1210/jc.2016-2740. View

18.

Genant H, Wu C, van Kuijk C, Nevitt M . Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993; 8(9):1137-48. DOI: 10.1002/jbmr.5650080915. View

19.

Kim E, Jeon Y, Pak K, Kim I, Kim S, Shin S . Effects of Thyrotropin Suppression on Bone Health in Menopausal Women with Total Thyroidectomy. J Bone Metab. 2019; 26(1):31-38. PMC: 6416151. DOI: 10.11005/jbm.2019.26.1.31. View

20.

Schott A, Cormier C, Hans D, Favier F, HAUSHERR E, Dargent-Molina P . How hip and whole-body bone mineral density predict hip fracture in elderly women: the EPIDOS Prospective Study. Osteoporos Int. 1998; 8(3):247-54. DOI: 10.1007/s001980050061. View