Jódar Gimeno E, Muñoz-Torres M, Escobar-Jiménez F, Quesada Charneco M, Luna del Castillo J D, Oleà N
Service of Endocrinology, University Hospital, 12 de Octubre, Madrid, Spain.
Calcif Tissue Int. 1997 Nov;61(5):370-6. doi: 10.1007/s002239900350.
Active hyperthyroidism is associated with reduced bone mass. Nevertheless, not all patients show the same risk for developing osteoporosis. Our aim was to analyze some clinical and biochemical potential predictors of low bone mass in hyperthyroid patients. We studied 127 consecutive hyperthyroid patients (110 females, 17 males; aged 42 +/- 16 years). Bone mineral density (BMD) was measured by dual X-ray absorptiometry (DXA) at lumbar spine (LS; L2-L4) and femoral neck (FN). Data were expressed as g/cm2 and T-score. Patients were placed into two groups based on recent WHO criteria: Group A, no osteoporosis (n = 98); and group B, lumbar or femoral osteoporosis (n = 29). Study protocol included evaluation of osteoporosis risk factors, anthropometrical variables, thyroid function, and bone turnover markers. Receiver-operating characteristic (ROC) plots for the precision of bone markers and multivariate analysis for the prediction of BMD and osteoporosis were performed. Group B showed greater age and proportion of menopausal females; lower weight, height, and calcium intake; longer duration of menopause; and greater levels of total and bone alkaline phosphatase and of urine hydroxyproline. No differences in thyroid function, osteocalcin, tartrate-resistant acid phosphatase, and type I collagen C-telopeptide (ICTP) were found. The best predictive model accounted for 46% and 62% of the variability of lumbar and femoral BMD respectively and correctly classified 89% of the osteoporotic hyperthyroid patients. No significant difference in ROC plots was observed. It is concluded that hyperthyroid patients with lumbar or femoral osteoporosis show a typical clinical and biochemical profile illustrating that the relationship between BMD and bone markers is better in high turnover states. Classical bone turnover markers show high performance in the evaluation of hyperthyroid bone disease.
甲状腺功能亢进症与骨量减少有关。然而，并非所有患者发生骨质疏松症的风险都相同。我们的目的是分析甲状腺功能亢进症患者低骨量的一些临床和生化潜在预测因素。我们研究了127例连续的甲状腺功能亢进症患者（110例女性，17例男性；年龄42±16岁）。采用双能X线吸收法（DXA）测量腰椎（LS；L2-L4）和股骨颈（FN）的骨密度（BMD）。数据以g/cm²和T值表示。根据世界卫生组织最近的标准将患者分为两组：A组，无骨质疏松症（n = 98）；B组，腰椎或股骨骨质疏松症（n = 29）。研究方案包括评估骨质疏松症危险因素、人体测量变量、甲状腺功能和骨转换标志物。绘制骨标志物精度的受试者操作特征（ROC）曲线，并进行多变量分析以预测BMD和骨质疏松症。B组患者年龄更大，绝经女性比例更高；体重、身高和钙摄入量更低；绝经持续时间更长；总碱性磷酸酶、骨碱性磷酸酶和尿羟脯氨酸水平更高。在甲状腺功能、骨钙素、抗酒石酸酸性磷酸酶和I型胶原C末端肽（ICTP）方面未发现差异。最佳预测模型分别解释了腰椎和股骨BMD变异性的46%和62%，并正确分类了89%的骨质疏松性甲状腺功能亢进症患者。ROC曲线未观察到显著差异。结论是，患有腰椎或股骨骨质疏松症的甲状腺功能亢进症患者具有典型的临床和生化特征，说明在高转换状态下BMD与骨标志物之间的关系更好。经典的骨转换标志物在评估甲状腺功能亢进性骨病方面表现出高性能。
