Decreased BMD observed in post-, not premenopausal women on TSH suppression
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Among adults with differentiated thyroid cancer on thyroid-stimulating hormone suppression therapy, postmenopausal women had lower bone mineral density at the lumbar spine whereas premenopausal women had greater BMD vs. healthy controls.
“Many differentiated thyroid cancers occur in relatively young people and are known to have a higher overall long-term survival rate than other malignancies; therefore, many patients are exposed to long-term TSH suppression therapy,” Eu Jeong Ku, MD, PhD, an associate professor in the department of internal medicine at Chungbuk National University Hospital in South Korea, told Healio. “For long-term differentiated thyroid cancer survivors receiving TSH suppression therapy, careful regular BMD monitoring should be considered.”
Researchers conducted a systematic review and meta-analysis of studies examining associations between TSH suppression therapy after a thyroidectomy and BMD in people with differentiated thyroid cancer compared with healthy controls. Researchers searched the PubMed, Embase, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov from inception to Jan. 4, 2021. Thyroid carcinoma, thyroidectomy and BMD were the key search terms. Mean BMD at the lumbar spine, femoral neck and total hip in the TSH suppression group compared with controls was collected for each study. Researchers analyzed associations for postmenopausal women, premenopausal women and men in the meta-analysis. The findings were published in the Journal of Endocrinology & Metabolism.
The meta-analysis included 739 adults receiving TSH suppression therapy and 1,085 controls in 17 studies. Postmenopausal women had lower lumbar spine BMD with TSH suppression compared with controls (mean difference, –0.03 g/cm2; 95% CI, –0.05 to –0.02; P < .001). Conversely, premenopausal women had a higher lumbar spine BMD with TSH suppression compared with controls (mean difference, 0.04 g/cm2; 95% CI, 0.02-0.06; P < .001). There was no difference in BMD observed for men receiving TSH suppression therapy compared with controls.
At the femoral neck, premenopausal women with TSH suppression had greater BMD compared with controls (mean difference, 0.02 g/cm2; 95% CI, 0.01-0.04; P = .009). No significant differences were observed for men or postmenopausal women. For total hip BMD, there were no significant differences between TSH suppression therapy and controls for women or men.
“There are several possible reasons for the discrepancy between the postmenopausal and premenopausal outcomes shown in this study,” the researchers wrote. “The first can be explained by the bone-protective effects of estrogen. ... Another possible explanation for our results may be that the effect of healthy behaviors of premenopausal women diagnosed with differentiated thyroid cancer at a relatively young age, such as healthy diet and increased physical activity, might have influenced the increase in BMD.”
Fourteen of the studies in the meta-analysis were defined as being well conducted, and researchers said the literature was of relatively high methodological quality.
“Further prospective clinical trials should be conducted to determine the effects of TSH suppression therapy on osteoporosis and even fractures in patients with thyroid cancer,” Ku said. “Therefore, it could be possible to present a patient-centered treatment that maintains a better quality of life, including an appropriate prevention for osteoporosis, for a large number of thyroid cancer patients.”
For more information:
Eu Jeong Ku, MD, PhD, can be reached at eujeong.ku@gmail.com.
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