Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, ;Republic of Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, ;Republic of Korea.
Front Endocrinol (Lausanne). 2023 Jul 20;14:1173781. doi: 10.3389/fendo.2023.1173781. eCollection 2023.
Levothyroxine suppressive therapy following thyroidectomy for thyroid cancer patients is considered as a risk factor for osteoporosis and fragility fractures. We evaluated the association of regular exercise and exercise habit change with fracture risk in adults older than 40 years who underwent thyroidectomy for thyroid cancer.
We enrolled the patients who underwent thyroidectomy for thyroid cancer older than 40 years between 2010 and 2016 from the Korean National Health Insurance Service data, and they were followed through 2019. Based on the questionnaire of health examination within 2 years before and after surgery, whether regular exercise once a week was evaluated. The reference group for the statistical analysis was the continuing lack of physical activity group that did not exercise before or after surgery. For fractures newly diagnosed during the follow-up period, univariate and multivariate Cox regression analyses were performed for risk evaluation.
We evaluated 74,774 subjects, of whom 2,924 (3.9%) experienced any fractures during a median follow-up of 4.5 years. Compared with the group consistently lack of physical activity, the group that exercised before and after surgery showed a significant decrease in the risk of any fracture, vertebral fracture, and hip fracture: adjusted hazard ratio 0.848 (95% Confidence Interval 0.771-0.932), 0.703 (0.591-0.836), and 0.405 (0.224-0.732), respectively. For vertebral fracture, a significant reduction in fracture risk was confirmed even in patients who started their regular exercise after surgery: adjusted hazard ratio 0.779 (0.648-0.936). The risk reduction for vertebral fractures upon the initiation of exercise was found to be significant in the high-risk groups of patients: women and total thyroidectomy patients.
We suggest that maintaining or starting regular exercise after surgery may help prevent fractures in thyroid cancer patients older than 40 years who have undergone thyroidectomy.
甲状腺癌患者甲状腺切除术后进行左甲状腺素抑制治疗被认为是骨质疏松症和脆性骨折的危险因素。我们评估了 40 岁以上甲状腺癌患者甲状腺切除术后定期运动和运动习惯改变与骨折风险的关系。
我们从韩国国家健康保险服务数据中招募了 2010 年至 2016 年间 40 岁以上接受甲状腺癌甲状腺切除术的患者，并随访至 2019 年。根据手术前和手术后 2 年内健康检查的问卷，评估是否每周定期运动一次。统计分析的参考组为手术前后均不运动的持续缺乏体力活动组。对于随访期间新诊断的骨折，进行单变量和多变量 Cox 回归分析以评估风险。
我们评估了 74774 名受试者，其中 2924 名（3.9%）在中位数为 4.5 年的随访期间发生任何骨折。与持续缺乏体力活动组相比，手术前和手术后运动的组任何骨折、椎体骨折和髋部骨折的风险均显著降低：调整后的危险比分别为 0.848（95%置信区间 0.771-0.932）、0.703（0.591-0.836）和 0.405（0.224-0.732）。对于椎体骨折，即使在手术后开始定期运动的患者中，也证实了骨折风险的显著降低：调整后的危险比为 0.779（0.648-0.936）。在女性和甲状腺全切除术患者等高危患者中，运动开始时椎体骨折的风险降低具有显著意义。
我们建议，对于 40 岁以上接受甲状腺切除术的甲状腺癌患者，手术后保持或开始定期运动可能有助于预防骨折。
