Int J Thyroidol.  2022 May;15(1):1-16. 10.11106/ijt.2022.15.1.1.

Evaluation and Management of Bone Health in Patients with Thyroid Diseases: a Position Statement from the Korean Thyroid Association

• Hong AR
• Ahn HY
• Kim BK
• Ahn SH
• Park SY
• Kim MH
• Lee J
• Cho SW
• Kang HC

• KMID: 2530119
• DOI: http://doi.org/10.11106/ijt.2022.15.1.1

Abstract

Thyroid hormones have an important physiological role in maintaining adult bone structure and strength. Therefore, thyroid dysfunction is inevitably associated with various degrees of skeletal consequences. Endogenous overt hyperthyroidism is an established cause of high bone turnover with accelerated bone loss, resulting in osteoporosis and an increased risk of fractures. Hyperthyroidism induced by thyroid stimulating hormone suppression therapy in patients with differentiated thyroid cancer also has emerged as a contributing factor to osteoporosis and fragility fractures. While, there is lack of evidence that hypothyroidism negatively affects bone health. Although there is growing clinical evidence of the importance of bone health in hyperthyroidism, clinical guidelines on how to evaluate and manage bone health in these diseases have not yet been published worldwide. The Task Force from the Korean Thyroid Association Committee of Clinical Practice Guideline has developed this position statement for the evaluation and management of bone health in patients with thyroid diseases, particularly focused on endogenous hyperthyroidism and thyroid stimulating hormone suppression therapyassociated hyperthyroidism in patients with differentiated thyroid cancer.

Keyword

Hyperthyroidism; Differentiated thyroid cancer; Thyroid stimulating hormone; Osteoporosis; Fracture

Figure

• 

  Fig. 1 Evaluation and management of bone health in (A) women and (B) men with hyperthyroidism. 1Ca/D＋Osteoporosis Tx, Treatment for osteoporosis is needed in combination with calcium and vitamin D replacement. 2Ca/D±Osteoporosis Tx, Treatment for osteoporosis can be considered in combination with calcium and vitamin D replacement. Anti-osteoporosis treatment includes anti-resorptive agents (e.g., bisphosphonate) and anabolic agents. Certain types of bisphosphonates (i.e., ibandronate) are not available in men. BMD: bone mineral density, Ca/D: calcium and vitamin D, DXA: dual-energy X-ray absorptiometry, Tx: therapy

• 

  Fig. 2 Evaluation and management of bone health in (A) women and (B) men with differentiated thyroid cancer under TSH suppressive therapy. 1The high-risk group for osteoporosis and fragility fractures includes a previous history of fragility fractures, more than 1 year of amenorrhea in women, having other medical diseases or taking medications that cause osteoporosis. 2Ca/D＋Osteoporosis Tx, Treatment for osteoporosis is needed in combination with calcium and vitamin D replacement. 3Ca/D±Osteoporosis Tx, Treatment for osteoporosis can be considered in combination with calcium and vitamin D replacement. Anti-osteoporosis treatment includes anti-resorptive agents (e.g., bisphosphonate) and anabolic agents. Certain types of bisphosphonates (i.e., ibandronate) are not available in men. BMD: bone mineral density, Ca/D: calcium and vitamin D, DTC: differentiated thyroid cancer, DXA: dual-energy X-ray absorptiometry, TSH: thyroid stimulating hormone, Tx: therapy

Reference

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