Li Xiaotao, Zhang Taotao, Zhang Hongling, Liu Shanshan, Tian Limin
The First School of Clinical Medicine, Lanzhou University, No.199 Donggang West Road, Chengguan District, Lanzhou, Gansu Province, 730000, China.
Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, Gansu Province, China.
BMC Endocr Disord. 2025 Jan 14;25(1):11. doi: 10.1186/s12902-024-01819-7.
Thyroid hormone plays an important role in accumulating bone development and regulating bone metabolism. It is established that hypothyroidism is linked to increased risk of osteoporosis and fracture. However, the effects of levothyroxine (LT4) treatment on bone for hypothyroid patients remain controversial.
A systematical search was conducted of several databases, from inception until December 9, 2022, and updated the search using the same search strategy on October 30, 2024, for studies evaluating the effects of LT4 treatment on bone in hypothyroidism including subclinical hypothyroidism (SCH) and overt hypothyroidism (OH). The data were reported using a random-effects model with a standardized mean difference (SMD) and 95% conference interval (CI).
Thirteen of the 5996 published articles were included in this meta-analysis. No significance was found in bone mineral density (BMD) at the lumbar spine between SCH patients treated with LT4 and control group either at baseline or after intervention. For OH, BMD at the lumbar spine was statistically lower in LT4 treatment group compared with healthy controls (HCs) (SMD: -0.28, 95%CI: -0.55, -0.02, P = 0.040, I = 52%). There were no differences in BMD at the femoral neck, trochanter, and Ward's triangle between OH patients treated with LT4 and HCs. In addition, BMD at the lumbar spine was significantly lower in males with OH undergoing LT4 treatment for a duration of less than five years compared to those treated over five years. Nevertheless, no significant differences were found in bone metabolism biomarkers between OH patients treated with LT4 and HCs.
This systematic review and meta-analysis demonstrated that there is a slight adverse effect of LT4 replacement therapy on bone and mineral metabolism in patients with OH, while no observed effect was found in SCH patients.
甲状腺激素在骨骼发育和骨代谢调节中起着重要作用。甲状腺功能减退与骨质疏松症和骨折风险增加有关，这一点已得到证实。然而，左甲状腺素（LT4）治疗对甲状腺功能减退患者骨骼的影响仍存在争议。
对多个数据库进行系统检索，检索时间从建库至2022年12月9日，并于2024年10月30日使用相同检索策略更新检索，以查找评估LT4治疗对甲状腺功能减退（包括亚临床甲状腺功能减退（SCH）和显性甲状腺功能减退（OH））患者骨骼影响的研究。数据采用随机效应模型报告，给出标准化均数差（SMD）和95%置信区间（CI）。
5996篇已发表文章中有13篇纳入本荟萃分析。LT4治疗的SCH患者与对照组在基线或干预后腰椎骨密度（BMD）均无显著差异。对于OH患者，LT4治疗组的腰椎BMD在统计学上低于健康对照组（HCs）（SMD：-0.28，95%CI：-0.55，-0.02，P = 0.040，I = 52%）。LT4治疗的OH患者与HCs在股骨颈、大转子和沃德三角区的BMD无差异。此外，LT4治疗时间小于5年的OH男性患者腰椎BMD显著低于治疗时间超过5年的患者。然而，LT4治疗的OH患者与HCs之间的骨代谢生物标志物无显著差异。
本系统评价和荟萃分析表明，LT4替代治疗对OH患者的骨和矿物质代谢有轻微不良影响，而在SCH患者中未观察到这种影响。
