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J Clin Endocrinol Metab. 2017 Nov 7. doi: 10.1210/jc.2017-01986. [Epub ahead of print]

HIGH PREVALENCE OF RADIOLOGICAL VERTEBRAL FRACTURES IN WOMEN ON TSH-SUPPRESSIVE THERAPY FOR THYROID CARCINOMA.

Author information

1
Endocrine Unit, Azienda Socio-Sanitaria Territoriale, Mantua, Italy.
2
Department of Molecular and Translational Medicine, University of Brescia, Italy.
3
Chair of Endocrinology.
4
Biochemistry, Vita-Salute San Raffaele University, Milan, Italy.
5
Laboratory of Experimental Biochemistry and Molecular Biology, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy.
6
Chair of Radiology.
7
Nuclear Medicine, University of Brescia, Italy.

Abstract

Context:

Bone loss and non-vertebral fractures have been reported in patients with differentiated thyroid carcinoma (DTC) undergoing TSH-suppressive therapy. Radiological vertebral fractures (VFs) are an early and clinically crucial marker of bone fragility but they have never been investigated so far in this specific clinical setting.

Objective and design:

In this cross-sectional study we evaluated the prevalence and determinants of radiological VFs in women under L-T4 therapy for DTC.

Patients and Interventions:

179 consecutive women (median age 59 years; all but one post-menopausal) already thyroidectomized for DTC and currently undergoing treatment with L-T4 (median duration of treatment 5 years) with different TSH target levels (Group I: 83 cases, TSH <0.5 mU/l; Group II: 50 cases, TSH 0.5-1.0 mU/l; Group III: 46 cases, TSH above 1.0 mU/l) were evaluated for radiological VFs and bone mineral density (BMD).

Results:

VFs were found in 51 patients (28.5%) with significantly (p<0.001) higher prevalence in Group I (44.6%) as compared to Group II (24.0%) and Group III (4.3%). In group I, prevalent VFs were not significantly different among patients with normal BMD, osteopenia or osteoporosis, whereas VFs were more frequent in patients with osteoporosis than either osteopenia or normal BMD with TSH values above 0.5 mU/l. In the whole population, VFs were significantly and independently associated with TSH <1.0 mU/l, diagnosis of osteoporosis at either skeletal site, age of patients and duration of L-T4 therapy.

Conclusions:

This is the first study showing high prevalence of VFs in women with DTC undergoing long-term suppressive L-T4 therapy.

PMID:
29121201
DOI:
10.1210/jc.2017-01986
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