Bone mineral density (BMD), bone turnover markers (BTMS) and evaluation of musculoskeletal system in patients with differentiated thyroid cancer undergoing TSH suppressive therapy

Laura Musso; Stefano Gay; Andrea Casabella; Sabrina Paolino; Maria Restelli; Elvis Hysa; Maurizio Cutolo; Marcello Bagnasco; Diego Ferone; Lara Vera

doi:10.1530/endoabs.101.PS1-05-09

PS1-05-09

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Endocrine Abstracts (2024) 101 PS1-05-09 | DOI: 10.1530/endoabs.101.PS1-05-09

ETA2024 Poster Presentations Clinical thyroid cancer research-1 (10 abstracts)

Bone mineral density (BMD), bone turnover markers (BTMS) and evaluation of musculoskeletal system in patients with differentiated thyroid cancer undergoing TSH suppressive therapy

Laura Musso ¹ , Stefano Gay ² , Andrea Casabella ³ , Sabrina Paolino ³ , Maria Restelli ⁴ , Elvis Hysa ³ , Maurizio Cutolo ³ , Marcello Bagnasco ⁵ , Diego Ferone ⁶ & Lara Vera ²

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¹University of Genova, O.U. Endocrinology, Department of Internal Medicine and Medical Specialities (Dimi), Genova, Italy; ²Irccs Ospedale Policlinico San Martino, O.U. Endocrinology, Genova, Italy; ³University of Genova, Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, Genova, Italy; ⁴University of Genova, Genova, Italy; ⁵University of Genoa, University of Genova, O.U. Endocrinology, Department OD Internal Medicine and Medical Specialities (Dimi), Genova, Italy, University of Genova, Genova, Genova, Italy; ⁶University of Genova, O.U. Endocrinology, Department OD Internal Medicine and Medical Specialities (Dimi), Genova, Italy

Background: The effect of L-thyroxine therapy on bone mineral density (BMD) in patients with differentiated thyroid carcinoma (DTC) is still controversial.

Objectives: The aim of this preliminary investigation was to evaluate the role of the evaluation of trabecular bone score (TBS) and body composition in addition to the BMD in a cohort of DTC patients.

Methods: The study involved a total of 104 patients who underwent total thyroidectomy for thyroid cancer, under LT4 therapy, in detail: 64 were females, 38 of them in post-menopausal state, aged 60,2±14,9 years (mean±SD), versus 58 age and sex matched healthy controls (CNT). Bone Mineral Density (BMD, g/cm²) at lumbar spine (L1- L4), total hip and Relative Skeletal Muscle mass Index (RSMI) in whole body composition were analyzed using a DXA scan [Lunar full-Prodigy (GE Lunar, Madison, WI, USA)]; Lumbar spine TBS (TBS iNsight Medimaps) was derived for each spine DXA examination; fasting blood sample were obtained in order to analyse some biochemical parameters namely: calcium, 25(OH) vitamin D, parathormone, TSH, FT3, FT4.

Results: DXA scan was performed a median of 48 months after surgery (2-563 months). At the time of data cut off DTC patients showed a significantly lower bone mass compared with CNT (P < 0.001). (Lumbar spine BMD 1.19±0.24 vs 1.35±0.14 g/cm 2 P = 0,007). 42 patients presented suppressed TSH levels (<0.5 mU/l) at the time of DXA scan, 37 of them (88%) for more than 12 months. In DTC patients, the T-score for L1-L4 adjusted for TBS was lower than the full T-score L1-L4 (- 1.4 vs -0.25, P < 0.001). The concordance between the TBS and the BMD in assessing the diagnosis of osteoporosis was mild (K=0,14). Mean TSH was 2,00±1.48 mU/l; FT3=3.29±1.61 pg/mL; FT4=13.19±3.87 pg/mL, PTH 45.3±33.1 ng/l, 25OHvitD 30.6±10.0 ng/mL, calcium 9.2±0.6 mg/dl. None of these variables proved related to the BMD (P> 0.10), while TBS proved related to calcium (P = 0.014) and PTH levels (P = 0.002). RSMI proved significantly positively related with bone trabecular quality (TBS) (r = 0.31; P = 0.001) and bone mineral content (BMD) (r = 0.46; P < 0.001).

Conclusion: This study suggests the usefulness of new diagnostic tools to investigate the effects of TSH suppressive therapy on skeletal mass and bone quality in patients under LT4 therapy after total thyroid ablation for DTC.