Measurements of Bone Health after Thyroid-Stimulating Suppression Therapy in Postmenopausal Women with Differentiated Thyroid Carcinoma: Bone Mineral Density versus the Trabecular Bone Score

Chae Won Chung,Sun Wook Cho,Hoon Sung Choi,Do Joon Park,Young Joo Park,Sung Hye Kong,Hwa Young Ahn

doi:10.3390/jcm10091964

Abstract

Background: Thyroid-stimulating hormone (TSH) suppression therapy is an important treatment modality for differentiated thyroid carcinoma (DTC), but it increases fracture risk. The aim of this study was to evaluate changes in bone mineral density (BMD) and trabecular bone score (TBS) in postmenopausal DTC patients receiving TSH suppression therapy. Methods: A total of 410 postmenopausal DTC patients who underwent thyroidectomy and had at least two dual-energy X-ray absorptiometry measurements, including a preoperative measurement, were included. Patients who had osteoporosis medication for more than 1 year were classified as ‘patients with osteoporosis’. Results: In patients without osteoporosis, the change in %BMD was similar between TSH suppression (−) and (+) groups, while the decrease in %TBS was significantly greater in the TSH suppression (+) group than that of the TSH suppression (−) group. The relative risk of vertebral fracture was decreased by TBS changes but not by BMD changes. In patients with osteoporosis, both BMD and TBS showed significant increases in the TSH suppression (−) group but not in TSH suppression (+) group. At year 4, TBS was significantly lower in the TSH suppression (+) group than that in the TSH suppression (−) group, while BMD showed no difference between groups. Conclusions: TBS may better reflect bone health than BMD in postmenopausal DTC patients with TSH suppression therapy.

Highlights

Differentiated thyroid carcinoma (DTC) is the most common endocrine cancer, and it has a favorable prognosis with low mortality rate [1,2]
Thyroid-stimulating hormone (TSH) suppression therapy is under debate as it was prolonged following the long-term survival of differentiated thyroid carcinoma (DTC) patients
Because the growth of thyroid cancer cells is enhanced by thyroid-stimulating hormone (TSH) through receptors expressed in cancer cells [4], TSH suppression therapy has been used to prevent recurrence of thyroid cancer since 1977 [5,6]

Summary

Introduction

Differentiated thyroid carcinoma (DTC) is the most common endocrine cancer, and it has a favorable prognosis with low mortality rate [1,2]. The thyroid cancer-specific mortality was 1.4% and the recurrence rate was 13.3% during a five-year follow-up in South. Thyroid-stimulating hormone (TSH) suppression therapy is under debate as it was prolonged following the long-term survival of DTC patients. The main reason for these side effects, especially the decrease in bone density, is persistent subclinical hyperthyroidism induced by TSH suppression therapy [7,11]. Decreased bone density places patients at an elevated risk for fragility fracture, which is problematic in older adults and is associated with a mortality rate of 20–33% at 1 year after fracture [14]. Given the high long-term survival rate of DTC, bone health monitoring is of paramount importance in DTC patients receiving TSH suppression therapy, especially in postmenopausal women, who are vulnerable to bone loss. Patients who had osteoporosis medication for more than 1 year were classified as ‘patients with osteoporosis’

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