Longitudinal changes in lumbar bone density among thyrotoxic patients after attainment of euthyroidism
CJ Rosen and RA Adler
Department of Endocrinology and Metabolism, St. Joseph Hospital, Bangor, Maine 04410.
Hyperthyroidism increases bone turnover, which, in turn, may lead to bone
loss from the spine and hip. Treatment of thyrotoxicosis may restore bone
mass, but there are few long term prospective studies. We examined lumbar
bone mineral density (BMD) in 21 subjects [11 with hyperthyroidism (HT) and
10 controls of similar age] by dual photon absorptiometry in 1986 and by
dual energy x-ray densitometry in 1991. All 11 HT patients were
successfully treated and remained euthyroid (mean TSH, 2.25 +/- 0.80 mU/L)
for more than 3 yr. Lumbar BMD increased 11.03 +/- 2.38% (P < 0.001) in
HT patients, but only 2.6 +/- 2.15% (P = 0.10) in control subjects. Among
HT patients, the higher the T3 concentration during hyperthyroidism, the
greater the subsequent increase in lumbar BMD (r = 0.72; P < 0.03). Age
at treatment, in contrast, was not a significant predictor of eventual
spinal bone mass. In conclusion, successful treatment of hyperthyroidism
produced a significant increase in lumbar BMD. Hence, bone loss associated
with thyrotoxicosis may not be permanent. Future work designed to examine
the effect of thyroid hormone on skeletal homeostasis should include large
scale longitudinal studies of both men and women.
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