ECE2017 Oral Communications Bone & Calcium Homeostasis (5 abstracts)
High prevalence of radiological vertebral fractures in patients with differentiated thyroid carcinoma undergoing L-thyroxine TSH-suppressive therapy
Anna Maria Formenti 1 , Gherardo Mazziotti 2 , Stefano Frara 3 , Filippo Maffezzoni 1 , Mauro Doga 3 , Francesco Bertagna 4 , Roberto Maroldi 5 , Maurizio Memo 1 , Raffaele Giubbini 4 & Andrea Giustina 3
1Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; 2Department of Internal Medicine, Mantua Hospital, Mantua, Italy; 3Chair of Endocrinology, Vita-Salute San Raffaele University, Milan, Italy; 4Chair of Nuclear Medicine, University of Brescia, Brescia, Italy; 5Chair of Radiology, University of Brescia, Brescia, Italy.
Thyroid hormones play a central role in the regulation of bone turnover and thyrotoxicosis is an established cause of secondary osteoporosis. Increased prevalence of reduced bone mineral density (BMD) has been reported even in patients with subclinical thyrotoxicosis such as those with differentiated thyroid carcinoma undergoing long-term L-thyroxine (L-T4) TSH-suppressive therapy. Morphometric vertebral fractures (VFs) are an early and clinically crucial marker of bone fragility but they have never been investigated so far in this setting. In this cross-sectional study, we evaluated the VF prevalence (DXA quantitative morphometry) and BMD (DXA Hologic 4500 W, at lumbar spine, total hip and femoral neck) in 53 consecutive patients with differentiated thyroid carcinoma (two males, 51 females; median age 61 years, range: 42–82; 45 with papillary carcinoma and eight with follicular carcinoma; median duration of therapy 5 years, range: 1–45) and 75 control subjects (72 females and three males; median age 62 years, range: 42–83) with normal thyroid function attending an outpatient bone clinic. VFs were significantly more prevalent in patients with thyroid carcinoma as compared to the control subjects (30.2 vs 9.3%; P=0.002) without significant (P=0.21) differences in BMD at either skeletal sites. BMD was not significantly different between fractured and non-fractured TSH suppressed patients at either skeletal site. Prevalence of VFs was not significantly (P=0.29) different among patients with normal BMD (11.1%), osteopenia (39.1%) and osteoporosis (28.6%). In patients under TSH-suppressive therapy, VFs were significantly associated with age (OR 1.1, C.I.95% 1.01–1.12; P=0.03) but not with duration of L-T4 therapy (OR 1.03; C.I.95% 0.96–1.11; P=0.34). This is the first study showing high prevalence of VFs in patients with thyroid carcinoma undergoing L-T4 TSH-suppressive therapy likely due to an impairment in bone quality. Vertebral morphometry should be performed at baseline and during follow-up of TSH-suppressed patients to assess their skeletal health.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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