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TSH suppression affects trabecular bone score in postmenopausal women
Thyroid-stimulating hormone suppression for at least 5 years decreased trabecular bone score at the lumbar spine in postmenopausal women with differentiated thyroid cancer, study data show.
Hak Chul Jang, MD, PhD, professor in the department of internal medicine at Seoul National University Bundang Hospital in Korea, and colleagues evaluated data from 273 postmenopausal women (mean age, 58.8 years) with differentiated thyroid cancer to determine the effect of TSH-suppressive therapy on trabecular bone score.
DXA was used to assess bone mineral density and trabecular bone score at the lumbar spine. The mean duration of TSH-suppressive therapy was 4.2 years before DXA evaluation, and all participants were on a stable dose of levothyroxine at DXA evaluation.
Lumbar spine BMD and trabecular bone score were negatively correlated with age at the time of DXA. Lumbar spine BMD was positively correlated with BMI, whereas BMI was negatively correlated with lumbar spine trabecular bone score, according to researchers. A positive correlation was found between BMD and levothyroxine dose, whereas average serum TSH levels during suppression were negatively correlated with trabecular bone score. Lumbar spine trabecular bone score was negatively correlated with duration of TSH suppression. After adjustment for age, BMI and BMD, longer duration of TSH suppression was independently related to lower lumbar spine trabecular bone score.
Participants with a shorter duration of TSH suppression were on higher doses of levothyroxine, had higher serum free thyroxine levels and lower serum TSH levels. Participants with longer duration of TSH suppression had decreased lumbar spine trabecular bone score; BMD was not significantly affected by duration of TSH suppression, the researchers wrote.
Participants with TSH suppression of at least 5 years had significantly lower lumbar spine trabecular bone score compared with participants with TSH suppression duration of less than 3 years after adjustment for age, BMI and BMD (P = .032).
“Longer duration of TSH suppression in postmenopausal [differentiated thyroid carcinoma] patients was associated with decreased vertebral bone strength by altering [trabecular bone score] rather than BMD,” the researchers wrote. “The deteriorative effect on vertebral [trabecular bone score] was observed in the patients whose duration of TSH suppression was ≥ 5 years despite their unaltered BMD. Our results suggest that long-term TSH suppression may result in the alteration of trabecular bone microarchitecture in postmenopausal [differentiated thyroid carcinoma] patients. [Trabecular bone score] should be considered when estimating the potential risk of vertebral bone fragility in postmenopausal [differentiated thyroid carcinoma] patients receiving long-term TSH-suppressive therapy.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.