Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy.
Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy.
J Endocrinol Invest. 2021 Mar;44(3):431-442. doi: 10.1007/s40618-020-01359-6. Epub 2020 Jul 21.
Osteoporosis and fractures are important comorbidities in patients with differentiated thyroid cancer (DTC), with potential negative impact on quality of life and survival. The main determinant of skeletal fragility in DTC is the thyrotropin (TSH)-suppressive therapy, which is commonly recommended to prevent disease's recurrence, especially in patients with structural incomplete response after thyroid surgery and radio-iodine therapy. TSH-suppressive therapy can stimulate bone resorption with consequent bone loss, deterioration of bone microstructure and high risk of fragility fractures. The skeletal effects of TSH-suppressive therapy may be amplified when thyroid cancer cells localize to the skeleton inducing alterations in bone remodelling, impairment of bone structure and further increase in risk of fractures. The management of skeletal fragility in DTC may be challenging, since prediction of fractures is a matter of uncertainty and data on effectiveness and safety of bone-active agents in this clinical setting are still scanty. This review deals with pathophysiological, clinical and therapeutic aspects of skeletal fragility of patients with DTC.
骨质疏松症和骨折是分化型甲状腺癌（DTC）患者的重要合并症，对生活质量和生存有潜在的负面影响。DTC 患者骨骼脆弱的主要决定因素是促甲状腺激素（TSH）抑制治疗，该治疗通常被推荐用于预防疾病复发，尤其是在甲状腺手术后和放射性碘治疗后结构不完全缓解的患者中。TSH 抑制治疗可刺激骨吸收，导致骨丢失、骨微结构恶化和脆性骨折风险增加。当甲状腺癌细胞定位在骨骼中时，TSH 抑制治疗的骨骼作用可能会放大，从而导致骨重塑改变、骨结构受损，并进一步增加骨折风险。DTC 患者的骨骼脆弱性的管理可能具有挑战性，因为骨折的预测是不确定的，并且关于在这种临床环境中骨活性药物的有效性和安全性的数据仍然很少。本综述涉及 DTC 患者骨骼脆弱的病理生理学、临床和治疗方面。
