治疗格雷夫斯病后骨密度和微结构的变化以及维生素 D 补充的影响。一项随机临床试验。
Changes in bone density and microarchitecture following treatment of Graves' disease and the effects of vitamin D supplementation. A randomized clinical trial.
机构信息
Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark.
出版信息
Osteoporos Int. 2024 Dec;35(12):2153-2164. doi: 10.1007/s00198-024-07241-y. Epub 2024 Sep 12.
UNLABELLED
Thyrotoxicosis leads to loss of bone mass. Vitamin D is important to bone health. In this randomized, placebo-controlled trial, we showed that bone restoration did not improve when adding vitamin D supplementation to standard care of Graves' disease thyrotoxicosis. Bone density and microarchitecture improved markedly with treatment of thyrotoxicosis.
PURPOSE
Vitamin D is important to skeletal health and ensuring a replete vitamin D status is recommended. In thyrotoxicosis, bone turnover is increased and bone mass density (BMD) reduced. We examined whether vitamin D supplementation improves bone recovery in thyrotoxicosis caused by Graves' disease (GD).
METHODS
Using a double-blinded design, hyperthyroid patients with GD were randomized to vitamin D3 70 µg/day (2800 IU) or similar placebo as add-on to antithyroid drugs (ATD). At baseline and 9 months, we measured BMD and bone architecture using DXA and high resolution peripheral quantitative computerized tomography. Bone turnover markers (BTM) were measured at 3 months also. Effect of vitamin D versus placebo and the response to ATD treatment were analyzed using linear mixed modelling.
RESULTS
Eighty-six GD patients were included (age 41 ± 14 years, 86% females). Compared to placebo, vitamin D3 did not improve BMD or microarchitecture. In response to ATD, BMD increased in the hip by 2% (95%CI: 1-4%). Cortical porosity decreased in tibia (- 7% [95%CI: - 12 to - 2%]) and radius [- 14% [95%CI: - 24 to - 3%]), and trabecular thickness increased (tibia (5% [95%CI: 2 - 9%]) and radius (4% [95%CI: 1-7%]). Changes in BTM, but not thyroid hormones, were associated with changes in BMD by DXA and with changes in the cortical compartment.
CONCLUSION
In newly diagnosed GD, 9 months of high dose vitamin D3 supplementation does not offer benefit by improving skeletal health. Treatment of thyrotoxicosis is associated with the recovery of BMD and microarchitecture.
GOV IDENTIFIER
NCT02384668.
未注明
甲状腺功能亢进症会导致骨量流失。维生素 D 对骨骼健康很重要。在这项随机、安慰剂对照试验中，我们表明，在 Graves 病甲状腺功能亢进症的标准治疗中添加维生素 D 补充剂并不能改善骨骼恢复。甲状腺毒症的治疗使骨密度和微结构明显改善。
目的
维生素 D 对骨骼健康很重要，确保维生素 D 充足的状态是很有必要的。在甲状腺功能亢进症中，骨转换增加，骨密度（BMD）降低。我们研究了 Graves 病（GD）引起的甲状腺功能亢进症中维生素 D 补充是否能改善骨骼恢复。
方法
采用双盲设计，将甲状腺功能亢进的 GD 患者随机分为维生素 D3 70μg/天（2800IU）或类似安慰剂，作为抗甲状腺药物（ATD）的附加治疗。在基线和 9 个月时，我们使用 DXA 和高分辨率外周定量计算机断层扫描测量 BMD 和骨结构。还在 3 个月时测量骨转换标志物（BTM）。使用线性混合模型分析维生素 D 与安慰剂的效果以及对 ATD 治疗的反应。
结果
共纳入 86 例 GD 患者（年龄 41±14 岁，86%为女性）。与安慰剂相比，维生素 D3 并不能改善 BMD 或微结构。在 ATD 治疗下，髋部 BMD 增加 2%（95%CI：1-4%）。胫骨（-7%[95%CI：-12 至-2%]）和桡骨（-14%[95%CI：-24 至-3%]）的皮质孔隙减少，而小梁厚度增加（胫骨（5%[95%CI：2-9%]）和桡骨（4%[95%CI：1-7%]）。DXA 测量的 BMD 变化以及皮质容积的变化与 BTM 的变化相关，而不是与甲状腺激素的变化相关。
结论
在新诊断的 GD 中，9 个月高剂量维生素 D3 补充并不能通过改善骨骼健康带来益处。甲状腺毒症的治疗与 BMD 和微结构的恢复有关。
政府标识符
NCT02384668
Zotero 插件