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Randomized Trial of Pamidronate in Patients with Thyroid Cancer: Bone Density Is Not Reduced by Suppressive Doses of Thyroxine, But Is Increased by Cyclic Intravenous Pamidronate¹

Charles A. Dana Research Institute and the Harvard-Thorndike Laboratory of the Beth Israel Deaconess Medical Center, Department of Medicine, Divisions of Gerontology (H.N.R., S.L.G.), Endocrinology (H.N.R., A.C.M., J.G., S.L.G.), and Bone and Mineral Metabolism (H.N.R., L.F., S.L.G., Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215; Endocrinology Section, Health Centers Division, Harvard Pilgrim HealthCare (J.G.), Boston, Massachusetts 02215; Thyroid Unit, Department of Medicine, Massachusetts General Hospital (D.S.R.), Boston, Massachusetts 02114; and Endocrinology, Diabetes, Metabolism and Molecular Medicine Division, Department of Medicine, New England Medical Center (S.L.L.), Boston, Massachusetts 02111

Address all correspondence and requests for reprints to: Harold N. Rosen, Division of Bone and Mineral Metabolism, RA414, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215.

Patients taking suppressive doses of T₄ are thought to have accelerated bone loss and increased risk of osteoporosis. We therefore randomize 55 patients taking suppressive doses of T₄ to treatment with pamidronate (APD) 30 mg iv every 3 months for 2 yr (APD/T₄), or placebo (placebo/T₄). Patients had measurements of bone mineral density (BMD) of the spine, hip, radius, and total body every 6 months for 2 yr. There was no significant bone loss at any site in the placebo/T₄ group. Ninety five percent confidence intervals excluded a rate of bone loss >0.89%/yr for the spine and >0.31%/yr at the total hip. When men were excluded from the analysis, there still was no significant bone loss for the placebo/T₄ group, and confidence intervals did not change. The APD/T₄ group showed increases in spine (4.3%, P = 0.0001), total hip (1.4%, P < 0.05), and trochanteric (3.0%, P = 0.0001) BMDs. In conclusion, premenopausal women and men on suppressive therapy with T₄ do not lose bone rapidly, and are not at increased risk of developing osteoporosis. A regimen of 30 mg APD given every 3 months for 2 yr causes significant suppression of bone resorption and increases in BMD, and may be an acceptable alternative treatment for osteoporosis in patients who cannot tolerate oral bisphosphonates.

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