Thyroid hormone use and bone mineral density in elderly women. Effects of estrogen
D. L. Schneider, E. L. Barrett-Connor and D. J. Morton
Department of Medicine, University of California-San Diego, La Jolla 92093-0607.
OBJECTIVE--To determine the effect of long-term use of thyroid hormone on
bone mineral density (BMD) in elderly women and the potential mitigating
effects of estrogen replacement therapy. DESIGN--Cross-sectional,
community-based study. SETTING--Rancho Bernardo, Calif. PARTICIPANTS--A
total of 991 white women aged 50 to 98 years who participated in a study of
osteoporosis. MAIN OUTCOME MEASURES--Bone mineral density at the
ultradistal radius and midshaft radius using single-photon absorptiometry
and at the hip and lumbar spine using dual-energy x-ray absorptiometry.
RESULTS--A total of 196 women taking thyroid hormone for a mean duration of
20.4 years were compared with 795 women who were not using thyroid hormone.
Women taking daily thyroxine-equivalent doses of 200 micrograms or more had
significantly lower BMD levels at the midshaft radius and hip compared with
those taking less than 200 micrograms. Daily doses of 1.6 micrograms/kg and
greater were associated with lower bone mass at all four sites compared
with nonuse, whereas doses less than 1.6 micrograms/kg were not associated
with lower BMD levels. These associations were independent of age, body
mass index, smoking status, and use of thiazides, corticosteroids, and
estrogen. Women taking both estrogen and a thyroid hormone dose of 1.6
micrograms/kg or greater had significantly higher BMD levels at all four
sites than women taking the same thyroid hormone dose alone. Women taking
both thyroid hormone and estrogen had BMD levels comparable with those
observed in women taking only estrogen. CONCLUSIONS--Long-term thyroid
hormone use at thyroxine-equivalent doses of 1.6 micrograms/kg or greater
was associated with significant osteopenia at the ultradistal radius,
midshaft radius, hip, and lumbar spine. Estrogen use appears to negate
thyroid hormone-associated loss of bone density in postmenopausal women.
The Clinical Significance of Subclinical Thyroid Dysfunction
Biondi and Cooper
Endocr. Rev. 2008;29:76-131.
ABSTRACT
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Postradiotherapy Pelvic Fractures: Cause for Concern or Opportunity for Future Research?
Small and Kachnic
JAMA 2005;294:2635-2637.
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Biondi et al.
Eur J Endocrinol 2005;152:1-9.
ABSTRACT
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Clinical Considerations in Premenopausal Osteoporosis
Gourlay and Brown
Arch Intern Med 2004;164:603-614.
ABSTRACT
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Bone mineral density in postmenopausal Caucasian, Filipina, and Hispanic women
Morton et al.
Int J Epidemiol 2003;32:150-156.
ABSTRACT
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Subclinical thyrotoxicosis
Al-Abadi
Postgrad. Med. J. 2001;77:29-29.
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Sexual Assault and Physical Health: Findings From a Population-Based Study of Older Adults
Stein and Barrett-Connor
Psychosom. Med. 2000;62:838-843.
ABSTRACT
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The Effect of Thyroid Hormone on Skeletal Integrity
Greenspan and Greenspan
ANN INTERN MED 1999;130:750-758.
ABSTRACT
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Suppressive Therapy for Thyroid Nodules
Dwarakanathan
Arch Intern Med 1998;158:1470-1470.
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Comparison of Tamoxifen Effects on the Actions of Triiodothyronine or Growth Hormone in the Ovariectomized-Hypothyroid Rat
Fitts et al.
J. Pharmacol. Exp. Ther. 1998;286:392-402.
ABSTRACT
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Treatment of Benign Nodular Thyroid Disease
Hermus and Huysmans
NEJM 1998;338:1438-1447.
FULL TEXT
Alternative Sequences of Thyrotropin and Free Thyroxine Assays for Routine Thyroid Function Testing: Quality and Cost
Nordyke et al.
Arch Intern Med 1998;158:266-272.
ABSTRACT
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Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Osteoporosis: Diagnosis and Treatment*{{dagger}}
LANE et al.
JBJS 1996;78:618-32.
FULL TEXT
THYROID REPLACEMENT, ESTROGEN, AND BONE LOSS
JWatch General 1994;1994:3-3.
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