Levothyroxine Dose and Fracture Risk According to the Osteoporosis Status in Elderly Women

In another study of the same author was noticed that there was an increase in the risk of any fracture within the first 10years after a diagnosis of hypothyroidism. No effect of levothyroxine on fracture risk was present in that research 32. Gonzalez-Rodriguez et al. did not find any association between hypothyroidism and decreased bone mineral density or vertebral and non-vertebral fractures among 400 women suffering from hypothyroidism 44.

Thyroid Hormone Physiology

Subclinical disorders of the thyroid gland, defined as TSH outside the reference range of values and FT3 and FT4 within the normal range, are more subtle diseases and the diagnosis is incidentally made during screening exams. The availability of sensitive assay for TSH has allowed recognition of a syndrome in which usually there are no signs or symptoms of thyrotoxicosis, but the serum TSH is subnormal. The incidence of subclinical hyperthyroidism increases with age, especially in women, and is present in about of 15% of women over the age of 60 46. Serum TSH may also progress to overt hyperthyroidism, particularly, in patients with autonomous thyroid nodules or multinodular goiter. A reduction in serum TSH can occur with euthyroid Graves’ disease, subacute thyroiditis, autonomous adenoma, multinodular goiter, or administration of amounts of thyroid hormone greater than that required for metabolic needs. Exogenous hyperthyroidism is due to iatrogenic over-replacement with thyroid hormone supplementation.

Thyroid eye disease

Two types of cells are constantly at work in your bones to allow your skeleton to grow and repair any damage such as fractures. Osteoporosis – literally ‘porous bones’ – is a medical condition whereby your bones become fragile and are more likely to break. Although osteoporosis can be treated it is better to prevent it in the first place.

Who is at risk for osteoporosis?

The skeleton is one of the largest organs in the body and has multiple physiological actions including the structural strength and integrity of the body, having an important role in the maintenance of normal serum level of calcium and phosphate.
TRα1 is considered as a main functional mediator of triiodothyronine in skeleton 5,11,12.
Therefore, the objective of our cohort study, which employed a nationwide claims database, was to evaluate the association between levothyroxine dosage and fracture risk.

This is truly a double whammy; rather than strengthening your bones, you’re possibly contributing to another troubling condition. In addition to many of the possible factors above, men tend to also suffer with bone loss because of low T. If more bone is lost than is replaced, your bones become less dense and you may develop osteoporosis. 5Included patients who were neither diagnosed with osteoporosis nor prescribed bisphosphonate. 2Included patients who were diagnosed with osteoporosis, regardless of bisphosphonate or raloxifene prescription status.

Thyroid function tests

Hypothyroidism is common in elderly women, with prevalence rates of 3% to 10% in the general population and 11% to 15% in the elderly population 1.
The hips and spine are the areas of most concern due to the fact that hip fractures take a long time to heal, especially in older folks.
With regard to the association between TSH and fasting glucose, a predominance of unaltered fasting glucoses (up to 110) was found, regardless of the TSH range and there was no statistically significant relationship found.
You should not use the information on this website for diagnosis or treatment of any health problem.
Untreated hypothyroidism in childhood leads to growth retardation or even growth arrest, disturbances of endochondral ossification, delayed bone age and persistent short stature 8,13,19.
Studies that analyzed the effect of subclinical hypothyroidism on lumbar spine bone mass density and femoral bone mass density.

An additional role in bone metabolism has been proposed for TSH, since the TSH receptor, although predominantly expressed in thyroid follicular cells, has been described in other tissues including osteoblasts and osteoclasts 22. TSH has been suggested as a key negative regulator of bone turnover, with a direct effect on osteoblastic bone resorption due to decreased local production of tumor necrosis factor-alpha 23. However, this hypothesis did not explain the increased risk of osteoporosis reported in patients with Basedow’s disease. Indeed, these patients have increased levels of circulating TSH receptor autoantibodies that stimulate the TSH receptor. Thus, another study showed that a high dose of TSH was unable to affect the differentiation or function of both osteoblasts and osteoclasts in vitro 24. These data would suggest that the skeletal abnormalities found in hypothyroidism are independent of systemic TSH.

The common hypothyroidism medication levothyroxine is linked to bone loss in older adults, according to a study presented at the Radiological Society of North America annual meeting on Dec. 1. Furthermore, replacement therapy with levothyroxine may be suspended if there is no clear benefit and is generally safe as long as excessive administration is avoided. Such factors as the dose of thyroxine and level of thyrotropin should be considered when it comes to analyzing these studies with conflicting results, while also taking into account issues related to the research design (1–3).

Living with thyroid disorders – QR codes

They detected no significant decrease in BMD or bone turnover markers according to TSH level or free T4 level. Also, the prevalence of osteoporosis and osteopenia was not increased in this study 48. They suggested that thyroxine alone didn’t have a significant effect on bone mineral density and hence on risk of osteoporotic fractures 49. Hypothyroidism is common in elderly women, with prevalence rates of 3% to 10% in the general population and 11% to 15% in the elderly population 1.

With some awareness and forethought, you won’t have to fall prey to delicate bones, poor posture, and being fracture-prone. But if you heed the suggestions below, you may see much better outcomes and the ability to leave the “porous” to the pumice stone. But you can slow loss by beefing up your foundation, which can help to ward off brittle bones. I’m certainly not anti-supplementation, but believe that we should be getting the majority of our vitamins, minerals, and nutrients from whole foods instead of pills substituting as foods. Although a direct action of T3 on osteoblasts and chondrocytes is recognized, the effect of T3 on osteoclasts is still unclear 33.

However, in practice, the majority of adults with TSH levels above the normal range receive thyroid hormone treatment. Resorption and formation of bone occurs throughout life and is a coordinated process that is regulated by basic multicellular units, that are activated to maintain skeletal strength and repair bone microdamage 31. The bone remodeling cycle, which is influenced by systemic hormones and local factors, is characterized by activation, resorption, reversal, and formation steps, and this turnover is greater in cancellous than in cortical bone. In this cycle in young adults, the amount of new bone formed in the resorptive cavity is equal to the amount resorbed by osteoclasts. When the activity of osteoclasts is enhanced and/or that of osteoblasts is reduced, there is a net loss of bone with an increased risk of osteoporosis 32.

On the contrary, in states of hyperthyroidism, there is a high bone turnover with a shortened remodeling time. The discrepancy between bone formation and resorption results in a negative balance with a net loss of bone. According to the fabricante synthroid present study, it seems that the treatment of hypothyroidism with thyroid hormones reduces both serum levels of TSH and bone density. In our study we observed a high prevalence of bone loss in patients treated with thyroxin, which although not related to the dose they are taking was related to the number of years for which they had been taking it. This clearly leads to the decision that we must be cautious in starting treatment and although subclinical hypothyroidism occurs in young people they should only be treated when it is really necessary to do so. Diamond and his collaborators found a decrease in femoral neck BMD in pre-and post-menopausal women with thyroid carcinoma treated with suppressive doses of thyroxin; the reduction in lumbar spine BMD was significant only in post-menopausal women.