Majima T, Komatsu Y, Doi K, Takagi C, Shigemoto M, Fukao A, Morimoto T, Corners J, Nakao K
Department of Endocrinology and Metabolism, Rakuwakai Otowa Hospital, Kyoto, Japan.
Osteoporos Int. 2006;17(7):1103-10. doi: 10.1007/s00198-006-0091-4. Epub 2006 Apr 7.
Although it has been established that hyperthyroidism leads to reduced bone mineral density (BMD), with accelerated bone turnover promoting bone resorption in female patients, there is a dearth of data for male patients with hyperthyroidism. This study evaluated BMD and bone metabolism in male patients with Graves' disease.
The study included 56 Japanese male patients with newly diagnosed Graves' disease and 34 normal Japanese male control subjects of similar age and body mass index. We used dual energy x-ray absorptiometry to measure BMD at sites with different cortical/cancellous bone ratios (lumbar spine, femoral neck, and distal radius).
At the lumbar spine and the distal radius, BMD and T-scores were significantly lower for patients than for controls. At the femoral neck, on the other hand, the same values were relatively, but not significantly, lower in patients than in controls. However, Z-scores at all three sites were significantly lower for patients than for controls. The Z -score at the distal radius of patients was significantly lower than that at their lumbar spine and femoral neck. In addition, Z-score at the distal radius correlated negatively with age, free thyroxine, thyroid stimulating hormone receptor antibodies, thyroid stimulating antibody, and urinary N-terminal telopeptide of type I collagen normalized by creatinine.
These results indicate a high prevalence of cortical bone loss in male patients with Graves' disease, especially elderly patients. We conclude that BMD measurement is crucial in all Graves' disease patients regardless of their gender and that the radial BMD as well as BMD at the lumbar spine and femoral neck should be monitored to effectively prevent bone loss and subsequent fracture.
尽管已经确定甲状腺功能亢进会导致骨矿物质密度（BMD）降低，加速的骨转换促进女性患者的骨吸收，但关于男性甲状腺功能亢进患者的数据却很少。本研究评估了格雷夫斯病男性患者的骨密度和骨代谢情况。
该研究纳入了56名新诊断为格雷夫斯病的日本男性患者以及34名年龄和体重指数相近的正常日本男性对照者。我们使用双能X线吸收法测量不同皮质骨/松质骨比例部位（腰椎、股骨颈和桡骨远端）的骨密度。
在腰椎和桡骨远端，患者的骨密度和T值显著低于对照组。另一方面，在股骨颈，患者的相同数值相对低于对照组，但差异不显著。然而，患者在所有三个部位的Z值均显著低于对照组。患者桡骨远端的Z值显著低于其腰椎和股骨颈的Z值。此外，桡骨远端的Z值与年龄、游离甲状腺素、促甲状腺激素受体抗体、促甲状腺抗体以及经肌酐标准化的I型胶原尿N端肽呈负相关。
这些结果表明，格雷夫斯病男性患者，尤其是老年患者，皮质骨丢失的患病率较高。我们得出结论，无论性别如何，对所有格雷夫斯病患者进行骨密度测量都至关重要，并且应监测桡骨骨密度以及腰椎和股骨颈的骨密度，以有效预防骨质流失和随后的骨折。
