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Low TSH and risk for osteoporosis: a review
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American Thyroid Association Spring Symposium
Thyrotoxicosis, or an excess of thyroid hormone in the body, is associated with low levels of throid-stimulating hormone. Data on the relationship between TSH and fracture are contrasting. In the Study of Osteoporotic Fractures, older postmenopausal women with TSH levels ≤0.1 had an unadjusted hip fracture RR of 3.4 vs. 1 for women with TSH levels 0.5 to 5.5. Furthermore, women with TSH levels ≤0.1 had an adjusted RR of 4.5 for vertebral fractures and an adjusted RR of 2.3 for nonspine fractures. According to Douglas C. Bauer, MD, the increased fracture risk was likely mediated by accelerated bone turnover and not rapid bone loss.
In contrast, preliminary results from the Women’s Health Initiative Observational Study revealed no association with low TSH but found an association with hip fracture and higher free thyroxine. Therefore, one cannot rule out the effect of elevated T4, he said. The question of whether treating low TSH can prevent fracture remains unanswered.
Bauer recommended maintaining TSH levels ≥0.1 unless there are clear indications to do otherwise. Also, he said to consider low TSH a risk factor for fracture; however, the benefits of current therapies, such as bisphosphonates, remain unknown. – by Katie Kalvaitis
People have become concerned about thyroid hormone and the skeleton in the last 10 to 15 years. There are a lot of data about this topic and from a practical point of view most patients do not need to worry too much. Some data are conflicting.
– John H. Lazarus, MD
Emeritus Professor, Clinical Endocrinology,
Cardiff
University School of Medicine, Wales
There are 13 million people in the United States who are diagnosed with hyperthyroidism and treated with thyroid hormone. As long as their dosage is properly maintained, they have nothing at all to be concerned about.
– Irwin L. Klein, MD
Associate Chairman of Medicine, North Shore University
Hospital, New York,
and Associate Program Director for Education in the
General Clinical Research Unit
For more information:
- Bauer DC. Thyrotoxicosis and the skeleton: how bad for the bones? Presented at: the American Thyroid Association Spring Symposium; March 28, 008; Washington.