26 Feb The influence of thyroid dysfunction on bone metabolism

The influence of thyroid dysfunction on bone metabolism

There are no studies showing a reduction in mortality in patients with subclinical hypothyroidism treated with thyroid hormone. With regard to the general symptoms of hypothyroidism, cohort studies have shown no significant difference in the presence of constipation, fatigue or lack of energy in patients with subclinical hypothyroidism and euthyroid patients (22). This study confirms that treatment with levothyroxine in patients with subclinical hypothyroidism does not have a negative impact on bone mass. It is reassuring to know that treatment of subclinical hypothyroidism does not affect the bones, as long as levothyroxine doses are tailored to keep a normal TSH level.

Factors that increase the risk of osteoporotic fractures include:

Guidelines suggest that if Hormone Replacement Therapy (HRT) is used for a defined period in women under the age of 60 with a clear indication of menopausal symptoms, the benefits outweigh the risk and also helps with osteoporosis. It is recommended you expose your skin to direct sunlight for minutes every day during the summer months. Everyone starts to lose some bone density from the age of 35 years and this is just a normal part of ageing. It is more common, however, in older women after the menopause, as they stop producing oestrogen, a hormone that protects the bones. After the menopause bone can be lost more rapidly over the next five to ten years.

Osteoporosis in patients with subclinical hypothyroidism treated with thyroid hormone

The peak bone mass achieved at maturity and the age of menopause are strong predictors of an increased risk for fracture. Bisphosphonates are the cornerstone for the treatment of osteoporosis 5 and are commonly prescribed for its treatment, both in women and men 6. More recently, other drugs (i.e., teriparatide and denosumab) are often prescribed and showed a safety profile 7, even when prescribed for therapy of non-unions 8. However, a surgical approach sometimes necessary, in particular, in the case of vertebral compression fractures 9. Lee et al. observed 94 females (mean age, 50.84 ± 11.43years) receiving L-T4 after total or near total thyroidectomy and radioactive iodine therapy for thyroid cancer.

Hypothyroidism

If your bone density is actually low, there are many therapies out there to treat osteoporosis. These treatments can be given while continuing on your thyroid replacement regimen. Thyroid hormones are necessary to normal development and function of human skeleton. Although it is still unclear if bone changes observed in state of thyrotoxicosis are related to lack of TSH or to excess of thyroid hormones or both of them. Subclinical hyperthyroidism also causes a small reduction in BMD and increased risk of fracture but only in men ant postmenopausal women. Then suppressive doses of T4 can contribute to reduced BMD due to patient’s sex and gender (in postmenopausal females).

Studies that analyzed the effect of exogenous subclinical hyperthyroidism on lumbar spine bone mass density and femoral bone mass density. We performed on PubMed a literature search for the articles published until January 2020 by using the search terms “subclinical hyperthyroidism”, “osteoporosis”, “bone mass density”, and “subclinical hypothyroidism”. In addition to estrogen loss, we tend to suffer from bone loss due to the standard American diet, poor nutrition, history of hysterectomy, alcohol use, smoking, a sedentary lifestyle, chemotherapy, and some prescription medications, including…thyroid hormone replacement. Because of rising number of newly diagnosed osteoporosis cases it is necessary to perform an active investigation for all potential secondary conditions which can lead to reduced bone mineral density. It is very important because osteoporotic fractures are directly related with dropped quality of life, disability and mortality. It is estimated that 40% of women and 13-22% of men aged about 50 will experience to the end of life at least one fracture connected with osteoporosis – mainly proximal femur, spine or forearm 2.

The Newsweek article also states, “… some individuals can break ribs just by coughing or sneezing, or develop long-term chronic pain through partial breakages in the spine.” Yes. This is obviously something you’d work with your medical provider on, but my strong opinion is that the best way to determine if estrogen HRT is warranted is with a DUTCH panel (dried urine testing for comprehensive hormones). And indeed, I’ve had a lot of clients over many years with an osteopenia/osteoporosis diagnosis. If you have questions or concerns about your thyroid disorder, you should talk to your doctor or specialist as they will be best placed to advise you.

Finally, BMD in adolescent girls treated with LT4 for subclinical hypothyroidism for 2–5 years had similar BMD to a control group 18. Polovina et al. noticed that postmenopausal patients with subclinical hypothyroidism, in particular of autoimmune origin, have higher FRAX scores and a thus greater risk for low-trauma hip fracture than euthyroid postmenopausal women 45. Tuchendler et al. noted that newly diagnosed hypothyroidism among premenopausal women (average age 33,37 ± 10,83) did not have an influence on bone density 28.

It is well known that overt hyperthyroidism has a detrimental effect on bone mass and fragility fractures due to a high bone turnover as documented by a shortened bone remodeling cycle, together with an increase in biochemical markers of bone resorption and bone formation 18. A total of 162 individuals, all over 65 years of age with subclinical hypothyroidism, were divided in 2 groups. Doses of levothyroxine given to the first group were increased as needed to maintain a normal TSH level. A year later, 98 participants were studied for their bone structure by measuring it with a specific bone density test, called peripheral quantitative computed tomography (pQCT). Measurement of bone structure by pQCT may allow for a better determination of the strength of the bone as compared with the traditional bone mineral density test. Thyroid hormone affects the rate of bone replacement so plays a crucial role in maintaining healthy bones.

• In contrast, bisphosphonates and raloxifene were considered protective factors against fracture 22.
• 4Included patients who were diagnosed with osteoporosis, but were not prescribed bisphosphonate or raloxifene.
• The bone remodeling cycle, which is influenced by systemic hormones and local factors, is characterized by activation, resorption, reversal, and formation steps, and this turnover is greater in cancellous than in cortical bone.
• Care must be taken to get the dose right, since an excess can lead to decreased bone mineral density, the onset of atrial arrhythmias and the precipitation of angina pectoris.
• Thyroid disorders are one of the major common disorders which may affect the bone density.

Ultrasonography, particularly in the calcaneous, is a rapid procedure, which does not use X-rays and may predict fracture risk. Data of both techniques are reported in terms of T scores (i.e., standard deviations from the young adult values) or Z scores (i.e., standard deviation from the synthroid levaquin expected normal values). DXA scanners are also used for vertebral fracture assessment, which offer a high degree of accuracy in diagnosing fractures 34.

• The term osteoporosis, derived from Latin, literally means “porous bones.” It’s a progressive condition characterized by structural deterioration of bone tissue, which indeed, is living tissue.
• It’s certainly not the only risk of thyroid HRT (hormone replacement therapy), but it’s one that’s in need of some serious consideration.
• Thyroid hormones are essential for growth and development during childhood and for the maintenance of bone in adulthood.
• Though the study showed a link between bone loss and levothyroxine, Ghotbi stressed that it didn’t prove causation and that there are other possible explanations for the bone loss.

The researchers used the Baltimore Longitudinal Study of Aging (BLSA), a prospective observational cohort study of community-dwelling older adults. Participants aged 65 and older who had at least two visits and thyroid function tests consistently within the reference ranges were included in Dr. Ghotbi’s study. Early and continuous treatment with LT4 has been shown to promote normal growth 8, 9 and BMD or other indices of bone health 10–12 in children with congenital hypothyroidism, relative to their euthyroid peers (Fig. 1), and normal BMD in adults 13. Maintenance of a healthy weight and calcium intake appears to be an important determinant of bone health in these children, as in other populations 11.