Endocrine Unit, Azienda Socio-Sanitaria Territoriale, Mantua, Italy.
Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
J Clin Endocrinol Metab. 2018 Mar 1;103(3):956-964. doi: 10.1210/jc.2017-01986.
Bone loss and nonvertebral fractures have been reported in patients with differentiated thyroid carcinoma (DTC) undergoing thyroid-stimulating hormone (TSH) suppressive therapy. Radiological vertebral fractures (VFs) are an early and clinically crucial marker of bone fragility.
A cross-sectional study to evaluate the prevalence and determinants of radiological VFs in women receiving l-thyroxine (L-T4) therapy for DTC.
A total of 179 consecutive women (median age, 59 years; n = 178 postmenopausal) who had undergone thyroidectomy for DTC and were currently receiving L-T4 were evaluated for radiological VFs and bone mineral density (BMD). There were three TSH target levels [<0.5 mU/L, group 1 (n = 83); 0.5 to 1.0 mU/L, group 2 (n = 50); >1.0 mU/L, group 3 (n = 46)].
VFs were found in 51 patients (28.5%), with significantly (P < 0.001) higher prevalence in group 1 (44.6%) as compared with group 2 (24.0%) and group 3 (4.3%). VF prevalence was not significantly different among patients in group 1 with normal BMD, osteopenia, or osteoporosis, whereas in groups 2 and 3, VFs were more frequent in patients with osteoporosis than in those with either osteopenia or normal BMD. In the whole population, VFs were significantly and independently associated with TSH level <1.0 mU/L; densitometric diagnosis of osteoporosis at lumbar spine, femoral neck, or total hip; age of patients; and duration of L-T4 therapy.
The prevalence of VFs was high in women with DTC who were undergoing long-term, suppressive L-T4 therapy.
甲状腺刺激激素（TSH）抑制治疗的分化型甲状腺癌（DTC）患者已报告有骨丢失和非椎体骨折。放射性椎体骨折（VF）是骨脆弱的早期和临床关键标志物。
一项横断面研究，评估接受 L-甲状腺素（L-T4）治疗的 DTC 女性患者的放射性 VF 患病率和决定因素。
共评估了 179 例连续接受 DTC 甲状腺切除术且目前正在接受 L-T4 治疗的女性患者，评估其放射性 VF 和骨密度（BMD）。有三个 TSH 靶标水平 [<0.5 mU/L，第 1 组（n = 83）；0.5 至 1.0 mU/L，第 2 组（n = 50）；>1.0 mU/L，第 3 组（n = 46）]。
51 例患者（28.5%）发现 VF，第 1 组（44.6%）明显高于第 2 组（24.0%）和第 3 组（4.3%）（P < 0.001）。第 1 组中 BMD 正常、骨质疏松或骨质减少的患者之间的 VF 患病率无显著差异，而在第 2 组和第 3 组中，骨质疏松症患者的 VF 比骨质减少或 BMD 正常的患者更常见。在整个人群中，VF 与 TSH 水平 <1.0 mU/L；腰椎、股骨颈或全髋关节的骨质疏松症诊断；患者年龄；和 L-T4 治疗的持续时间显著且独立相关。
长期接受抑制性 L-T4 治疗的 DTC 女性患者 VF 的患病率较高。
