Fracture rates similar between adults with Graves’ disease and general population
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Key takeaways:
- Adults with Graves’ disease have a similar risk for osteoporosis-related fractures as adults without Graves’ disease.
- Men older than 52 years at Graves’ disease diagnosis have a higher risk for fracture.
Adults with Graves’ disease do not have an increased risk for an osteoporosis-related fracture later in life compared with those without Graves’ disease, according to data from a retrospective study published in Thyroid.
“Long-term observations of a large cohort of patients with previous Graves’ disease shows no significant differences in fracture rates compared to up to 10 controls from the general population,” Selwan Khamisi, MD, PhD, assistant professor in the department of medical sciences, endocrinology and mineral metabolism at Uppsala University in Sweden, and colleagues wrote. “A subanalysis shows that older men likely have an increased risk of vertebral fractures but due to the limited number of events, no firm conclusion can be made.”
Researchers conducted a retrospective cohort study of 2,134 adults diagnosed with Graves’ disease in Sweden from 2003 to 2005 (median age, 46 years). Data were collected from population-based registries from the Swedish National Board of Health and Welfare and from Statistics Sweden. Incidence of osteoporosis-related fractures were collected. Each adult with Graves’ disease was matched by sex, year of birth and county of residence with 10 randomly selected adults without Graves’ disease from the Swedish Population Register. Follow-up continued until fracture data, emigration from the country, death or the end of the study on Dec. 31, 2019.
During a median follow-up of 15.2 years, 9.1% of adults with Graves’ disease and 9% of the control group had an osteoporosis-related fracture. The median age of first recorded osteoporosis-related fracture was 68 years. There was no difference in the risk for osteoporosis-related fractures between the Graves’ disease and control groups. No differences were observed in the incidence rates for hip, vertebral or arm fractures. There were also no differences in fracture risk observed among age groups or when women and men were analyzed separately.
After adjusting for comorbidities as well as fractures and falls that occurred prior to baseline, men with Graves’ disease older than 52 years had a higher risk for an osteoporosis-related fracture than older men without Graves’ disease (adjusted HR = 2.83; 95% CI, 1.05-7.64).
“Men generally tend to experience more severe Graves’ orbitopathy and therefore should have received at least as much corticosteroid treatment, if not more,” the researchers wrote. “However, our data show that men older than age 52 years received less corticosteroid treatment compared to the other individuals with Graves’ disease included in the study, that is, steroids had no impact on the higher incidence of vertebral fractures in these men. The fact that men older than age 52 years did not receive more osteoporosis treatment or corticosteroids raises the suspicion that hyperthyroidism per se may have an impact on the increased incidence of vertebral fractures.”
When osteoporosis treatments and corticosteroid use were analyzed, the Graves’ disease group received higher rates of treatment than the control group. However, the findings regarding the risk for fractures remained unchanged in models adjusting for osteoporosis treatments and corticosteroids.
“Further studies focusing on older adult males with Graves’ disease should be performed to verify these findings,” the researchers wrote.
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