Department of Internal Medicine 1, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
Health and Nutrition, The University of Shimane, Matsue, Shimane, Japan.
J Bone Miner Metab. 2020 Mar;38(2):264-270. doi: 10.1007/s00774-019-01053-5. Epub 2019 Oct 29.
Thyroid-stimulating hormone (TSH)-suppressive therapy is recommended after surgical treatment in high-risk papillary thyroid carcinoma (PTC) patients. TSH-suppressive therapy is a known risk factor for osteoporosis and fractures. However, whether patients with PTC themselves are at a higher risk of osteoporosis than healthy individuals remains unclear. This study aimed to clarify whether PTC is a risk factor for osteoporosis.
Serum and urinary biochemical parameters, bone mineral density (BMD), and presence of vertebral fractures (VFs) and non-VFs were evaluated in 35 PTC patients and 35 age- and sex-matched healthy individuals. We compared the parameters between PTC and control subjects and performed multiple logistic regression analyses after adjustments for variables.
Patients with PTC had higher body mass index (BMI) and hemoglobin (Hb)A1c, as well as lower eGFR and intact PTH than controls (p < 0.05, each). There were no significant differences in the prevalence of osteoporosis and VFs and non-VFs between patients with PTC and controls. However, the prevalence of severe osteoporosis diagnosed according to WHO criteria was significantly higher in PTC subjects (34.3%) than in controls (11.4%, p < 0.05). Multivariate logistic regression analyses adjusted for age, BMI, eGFR and HbA1c identified PTC as being associated with the presence of severe osteoporosis (odds ratio, 4.20; 95% confidence interval, 1.05-16.8; p < 0.05).
We identified PTC as a risk factor for severe osteoporosis, independent of BMI, renal function and glucose profile.
在高危甲状腺乳头状癌(PTC)患者的手术后,建议进行促甲状腺激素(TSH)抑制治疗。TSH 抑制治疗是骨质疏松症和骨折的已知危险因素。然而,PTC 患者本身是否比健康个体更容易发生骨质疏松症尚不清楚。本研究旨在阐明 PTC 是否是骨质疏松症的危险因素。
评估了 35 例 PTC 患者和 35 名年龄和性别匹配的健康个体的血清和尿生化参数、骨密度(BMD)以及椎体骨折(VF)和非 VF 的存在情况。我们比较了 PTC 患者和对照组的参数,并在调整了变量后进行了多变量逻辑回归分析。
PTC 患者的体重指数(BMI)和血红蛋白 A1c(HbA1c)较高,而估算肾小球滤过率(eGFR)和完整甲状旁腺激素(iPTH)较低,与对照组相比差异有统计学意义(p<0.05,每项)。PTC 患者和对照组的骨质疏松症和 VF 及非 VF 的患病率无显著差异。然而,根据世界卫生组织(WHO)标准诊断的严重骨质疏松症的患病率在 PTC 患者中明显更高(34.3%),而在对照组中为 11.4%(p<0.05)。经年龄、BMI、eGFR 和 HbA1c 调整的多变量逻辑回归分析确定 PTC 与严重骨质疏松症的发生相关(比值比,4.20;95%置信区间,1.05-16.8;p<0.05)。
我们确定 PTC 是严重骨质疏松症的一个危险因素,与 BMI、肾功能和血糖状况无关。