Park Hyunju, Park Jun, Yoo Heejin, Kim Seonwoo, Koh Jang Hyun, Jee Jae Hwan, Min Yong-Ki, Chung Jae Hoon, Kim Tae Hyuk, Kang Mira, Kim Sun Wook
Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Endocrinology, Department of Medicine, Sahmyook Medical Center, Seoul, Korea.
Clin Endocrinol (Oxf). 2022 Jul;97(1):130-136. doi: 10.1111/cen.14698. Epub 2022 Feb 25.
Thyrotropin (TSH) suppression therapy is a standard treatment after surgery for differentiated thyroid carcinoma (DTC). It may be associated with osteoporosis in postmenopausal women. However, there are no guidelines for bone mineral density (BMD) testing intervals to screen for osteoporosis in these patients. Therefore, we evaluated the timing of repeated BMD testing in DTC patients with TSH suppression according to baseline T-scores.
DESIGN, PATIENTS, AND MEASUREMENT: We retrospectively evaluated 658 DTC patients who underwent BMD testing more than twice between January 2007 and January 2020. A 1:3 propensity score matching was conducted to compare the timing of repeated BMD tests between the DTC and non-DTC groups. We stratified the participants into four groups based on their baseline T-scores: normal (-1.00 or higher), mild osteopenia (-1.01 to -1.49), moderate osteopenia (-1.50 to -1.99), and severe osteopenia (-2.00 to -2.49). Additionally, the 10% of patients in each group that transitioned to osteoporosis were analysed.
The estimated BMD testing interval for 10% of patients who developed osteoporosis was 85 months for patients with initially mild osteopenia, 65 months for those with moderate osteopenia, and 15 months for those with severe osteopenia in the DTC group. In the non-DTC group, the testing intervals for mild, moderate, and severe osteopenia were 98, 57, and 13 months, respectively. On multivariate analysis, baseline T-score (mild osteopenia: hazard ratio [HR] 5.91, p = .105; moderate osteopenia: HR, 25.27, p = .02; and severe osteopenia: HR, 134.82, p < .001) and duration of TSH suppression (tertile 2: HR, 2.25, p = .005; Tertile 3: 1.78, p = .033) were independent risk factors for osteoporosis in the DTC group.
This study provides guidance for the timing of repeated BMD tests in women over 50 years of age with TSH suppression. The rescreening interval for BMD testing can be modified based on the baseline T-score. The appropriate BMD testing intervals in female DTC patients were similar to those in non-DTC females.
促甲状腺激素（TSH）抑制治疗是分化型甲状腺癌（DTC）术后的标准治疗方法。它可能与绝经后女性的骨质疏松症有关。然而，对于这些患者，尚无关于骨密度（BMD）检测间隔以筛查骨质疏松症的指南。因此，我们根据基线T值评估了接受TSH抑制治疗的DTC患者重复进行BMD检测的时机。
设计、患者与测量：我们回顾性评估了2007年1月至2020年1月期间接受两次以上BMD检测的658例DTC患者。进行了1:3倾向评分匹配，以比较DTC组和非DTC组重复进行BMD检测的时机。我们根据参与者的基线T值将其分为四组：正常（-1.00或更高）、轻度骨质减少（-1.01至-1.49）、中度骨质减少（-1.50至-1.99）和重度骨质减少（-2.00至-2.49）。此外，对每组中转变为骨质疏松症的10%的患者进行了分析。
在DTC组中，最初为轻度骨质减少的患者发展为骨质疏松症的10%患者的估计BMD检测间隔为85个月，中度骨质减少患者为65个月，重度骨质减少患者为15个月。在非DTC组中，轻度、中度和重度骨质减少的检测间隔分别为98、57和13个月。多因素分析显示，基线T值（轻度骨质减少：风险比[HR]5.91，p = 0.105；中度骨质减少：HR 25.27，p = 0.02；重度骨质减少：HR 134.82，p < 0.001）和TSH抑制持续时间（第二三分位数：HR 2.25，p = 0.005；第三三分位数：1.78，p = 0.033）是DTC组骨质疏松症的独立危险因素。
本研究为50岁以上接受TSH抑制治疗的女性重复进行BMD检测的时机提供了指导。BMD检测的重新筛查间隔可根据基线T值进行调整。女性DTC患者合适的BMD检测间隔与非DTC女性相似。
