Thyroid Hormone Diseases and Osteoporosis

Having a relative excess of thyroid hormone can increase bone resorption and lead to a breakdown of bone tissue, resulting in the bone disease osteoporosis. At the end of the first decade of the third millennium, the controversy continues over the need to treat mild hypothyroidism, known as subclinical hypothyroidism (SCH). Those who treat with substitution therapy claim that it can deal with some symptoms that may be due to thyroid failure, prevent the condition advancing to overt hyperthyroidism and produce cardiovascular benefits. Although theoretically treatment may prevent progression to overt hypothyroidism, improve lipid profile (and hence cardiovascular mortality) and improve symptoms, no studies of sufficient quality to prove this exists. The HIRA database was used as a data source, and accurate verification of the starting point, duration, and dosage of the drugs was available during the study period. Consequently, information bias, especially recall bias, was possibly minimal.

This condition is present when TSH suppressive therapy is prescribed in patients with differentiated carcinoma of thyroid or with benign uninodular or multinodular goiter. Exogenous administration of suppressive doses of thyroxine may have a negative effect on BMD. Diamond and colleagues found a decrease in femoral neck BMD in pre-and postmenopausal women with thyroid carcinoma treated with suppressive doses of thyroxin, reduction in lumbar spine BMD was significant only in postmenopausal women. Exogenous administration of suppressive doses of thyroxin may have a negative effect on BMD. Diamond and his collaborators found a decrease in femoral neck BMD in pre- and postmenopausal women with thyroid carcinoma treated with suppressive doses of thyroxin, the reduction in lumbar spine BMD was significant only in postmenopausal women (34). The progressive bone loss is due to an increased bone resorption, which is the major mechanism for increased bone fragility.

Who is at risk for osteoporosis?

The bone loss is more evident in vertebral bodies since the trabecular component is metabolically very active and decreases significantly when estrogen is deficient.
Decreased bone mass and increased fragility in age-related osteoporosis can occur because of failure to achieve optimal peak bone mass.
Such procedures should not be delayed because there is no evidence of increased risk of complications or mortality, even in cases of established hypothyroidism (12–14).
Thyroid hormone is crucial for cartilage growth and differentiation and enhances the response to growth hormone.
And again, some prescription medications, including statins, blood thinners, and chemotherapy drugs.
This test is commonly used as a part of follow-up in patients with differentiated thyroid cancer and gives the opportunity to test in vivo the effect of increased concentration of TSH on bone turnover markers.

Society’s aging causes that the number of people with osteoporotic fracture in Poland will amount in year 2025 about 3.23 millions. Besides, unfortunately a trend appeared that osteoporosis, mainly secondary, is diagnosed in more and more younger age groups. The most widely used method for measuring bone mass is dual-energy X-ray absorptiometry (DXA). The technic provides accurate values for bone mineral content (BMC) and BMD in the lumbar spine, the proximal femur, the distal radius, and the whole body, with minimal radiation exposure.

Levothyroxine Dose and Fracture Risk According to the Osteoporosis Status in Elderly Women

The phase of bone formation is reduced in 2/3, which effects in loss of over 10% mineralized bone on one cycle 21. In consequence thyrotoxicosis leads to increased risk of fractures 8,13,20,22. Elevated serum concentrations of IL-6 are observed in people with hyperthyroidism 23,24.

These changes lead to an uncoupling between resorption and formation, with the net result of loss of mineralized bone in varying amounts depending on factors such as sex, menstrual function, thyroid disease severity and sum of other risk factors for osteoporosis (31–34). Patients diagnosed with subclinical hypothyroidism receiving thyroid hormone replacement therapy. Determinants of bone health in patients receiving TSH-suppressive therapy appear to be complex and multifactorial. A family history of osteoporosis and oestrogen deficiency have been identified as risk factors for adverse effects on bone in this population 57, 58, 82.

You are welcome to contact the British Thyroid Foundation for further synthroid psyllium information and support, or if you have any comments about the information contained in this leaflet. Thyroid problems often run in families and if family members are unwell they should be encouraged to discuss with their own GP whether thyroid testing is warranted. HIRA, Korean Health Insurance Review and Assessment Service; LT3, liothyronine; LT4, levothyroxine; PDC, proportion of days covered. The images or other third party material in this chapter are included in the chapter’s Creative Commons license, unless indicated otherwise in a credit line to the material.

The present study also showed that at the time of diagnosis of hypothyroidism, BMD was not significantly different from normal subjects. Interestingly, the patients that received 2 years of levothyroxine replacement therapy had lower bone density. Thus, simultaneous treatment of hypothyroidism and bone loss seems to be necessary. Vestergaard et al. noted that there was a temporary increase in fracture risk within the first 2years after diagnosis of primary idiopathic hypothyroidism. The fracture risk was mainly increased in the age group above 50 years, and the increased risk was limited to the forearms 43.

Nevertheless, it is considered that hypothyroidism is related with increased risk of fractures, although their mechanism remains unclear 9. Hanna et al. noted that there was no evidence for a difference in bone mineral density in patients receiving replacement doses of thyroxine irrespective of the etiology of hypothyroidism 41. Leger et at proved that LT4 replacement therapy among children with congenital hypothyroidism is not detrimental to the skeletal mineralization 42.

Experiences of young people living with an endocrine disorder

However, he said he would have liked to see participants’ TSH levels and know why patients were put on levothyroxine to begin with. If you’re concerned about bone health, there’s nothing wrong with taking a calcium-magnesium supplement, although I lean towards a multi-mineral myself, not only for bone health, but also for thyroid and hair support. Um, okay, but just because the risk is in “older adults” and “the elderly” doesn’t mean that we want to wait until we’re “older” or “elderly” to find out that our bones are porous. Secondly, some doctors know little to nothing about the importance of magnesium and bone health. If calcium isn’t mobilized into the bone with the aid of magnesium, it may collect in soft tissues and again, cause calcium deposits and also arthritis.

These effects are particularly observed in postmenopausal women but are less evident in premenopausal women. Overt hypothyroidism is known to lower bone turnover by reducing both osteoclastic bone resorption and osteoblastic activity. These changes in bone metabolism would result in an increase in bone mineralization. At the moment, there are no clear data that demonstrate any relationship between BMD in adults and hypothyroidism.