Effects of thyroid-stimulating hormone suppression after thyroidectomy for thyroid cancer on bone mineral density in postmenopausal women: a systematic review and meta-analysis

ObjectivesWe assessed thyroid-stimulating hormone (TSH) suppression effects on bone mineral density (BMD) in postmenopausal women who underwent thyroidectomy.Data sourcesPubMed, EMBASE, Cochrane Library, Web of Science and SCOPUS were searched from inception to 24 February 2021.Study selectionCase-control studies were included.Data extraction and synthesisTwo authors independently reviewed the studies, extracted the data and performed meta-analysis of eligible studies.Research design and methodsStudies evaluating BMD in postmenopausal women with thyroid cancer who had thyroidectomy and levothyroxine therapy were included. Differences in BMD were presented as standardised mean differences (SMDs). Meta-analyses were conducted using a random-effects model.ResultsAnalysis of 16 case-control studies (426 patients and 701 controls without thyroid cancer) showed that stringent TSH suppression (TSH <0.10 mIU/L) after thyroidectomy had deleterious effects on the BMD of the lumbar spine in postmenopausal women compared with controls (SMD −0.55; 95% CI −0.99 to −0.10; I2=75.8%). There was no significant difference in patients with moderate TSH suppression (TSH 0.10–0.49 mIU/L). TSH suppression in postmenopausal women was not significantly associated with lower femoral neck BMD. Subgroup analysis of the lumbar spine showed that the association between stringent TSH suppression and lower BMD was consistent among studies with >10 years of follow-up (SMD −0.32; 95% CI −0.50 to −0.14). Subgroup analysis of the femoral neck showed that total thyroidectomy was related to detrimental effects on the BMD of the femoral neck (SMD −0.60; 95% CI −0.89 to −0.31; I2=90.4%), but near-total thyroidectomy was not (SMD 0.00; 95% CI −0.30 to 0.30; I2=55.6%).ConclusionsStringent TSH suppression had deleterious effects on the BMD of the lumbar spine after thyroidectomy in postmenopausal women. Further studies are needed to determine whether stringent TSH suppression after thyroidectomy increases the fracture risk.

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Effect of TSH Suppression Therapy on Bone Mineral Density in Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab539 ◽

2021 ◽

Author(s):

Eu Jeong Ku ◽

Won Sang Yoo ◽

Eun Kyung Lee ◽

Hwa Young Ahn ◽

Seung Hoon Woo ◽

...

Keyword(s):

Bone Mineral Density ◽

Thyroid Cancer ◽

Postmenopausal Women ◽

Observational Studies ◽

Differentiated Thyroid Cancer ◽

Meta Analysis ◽

Mineral Density ◽

Tsh Suppression ◽

Tsh Suppression Therapy

Abstract CONTEXT As subclinical hyperthyroidism increases the risk of osteoporosis and fractures, concerns are growing about the long-term skeletal safety of thyrotropin (TSH) suppression therapy after total thyroidectomy in patients with differentiated thyroid cancer (DTC). OBJECTIVE We aimed to determine the effect of TSH suppression therapy on bone mineral density (BMD) in DTC patients. METHODS We searched PubMed, Embase, the Cochrane library, and other sources. Eligible observational studies included DTC patients who underwent TSH suppression therapy and BMD measurement. Two independent reviewers extracted data on the studies’ characteristics and outcomes and determined their risk of bias. Data were extracted from each study for postmenopausal/premenopausal women’s and men’s lumbar spine (LS), femoral neck (FN), and total hip (TH) BMD and summed using a random-effects meta-analysis model. The weighted mean difference (WMD) with 95% confidence intervals (CI) are expressed for the differences in outcome measurements between groups. RESULTS Seventeen studies (739 patients and 1085 controls) were included for quantitative analysis. In postmenopausal women, TSH suppression therapy showed a significant decrease in LS BMD (-0.03; -0.05, -0.02), and a similar trend was seen in TH. In premenopausal women, TSH suppression therapy significantly increased LS BMD (0.04; 0.02, 0.06) and FN BMD (0.02; 0.01, 0.04). In men, there was no significant association between TSH suppression therapy and BMD at any site compared to the controls. CONCLUSION Evidence from observational studies suggests that postmenopausal women treated with TSH suppression therapy are at risk for lower BMD. Attention should be paid to long-term skeletal safety in DTC survivors.

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BMD status of Postmenopausal Women in relation with BMI: A study with 93 cases

Bangladesh Journal of Nuclear Medicine ◽

10.3329/bjnm.v17i2.28200 ◽

2016 ◽

Vol 17 (2) ◽

pp. 138-141

Author(s):

Samira Sharmin ◽

Mabubul Haque ◽

Syedur Rahman Miah ◽

Md Mahbub Ur Rahman ◽

Jasmine Ara Haque ◽

...

Keyword(s):

Lumbar Spine ◽

Femoral Neck ◽

Postmenopausal Women ◽

Lumbar Vertebrae ◽

The Body ◽

Mineral Density ◽

Cross Sectional ◽

T Score ◽

Minimal Trauma ◽

The Mean

Objectives: Low bone mass is a common disorder in elderly population which predisposes to fracture with minimal trauma. This study was performed to find out the association between the Body Mass Index (BMI) and Bone Mineral Density (BMD) in postmenopausal women.Materials and Methods: This cross sectional study was carried out at Institute of Nuclear Medicine and Allied Sciences Comilla and Mitford, Dhaka over a period of 12 months from January 2013 to December 2013. A total 93 postmenopausal women were enrolled for this study. All postmenopausal women underwent a BMD scan of femoral neck and lumbar vertebrae using a Dual Energy X-ray Absorptiometry (DEXA). Participants were categorized into three groups according to their age and BMI. BMD were expressed base on T-score according to WHO criteria. The relation among BMI, age and BMD were assessed.Results: The results of this study showed that the mean age of the study group was 57.13±7.49 years with range of 46 to 75 years. The most postmenopausal women were in age group 55-65years. The mean BMI of the study subjects were 24.18±5.08 kg/m2 with a range of 15.62 to 36.20 kg/m2. Among 93 subjects osteopenia was greater at lumbar spine (45.2%) with T-score mean±SD-1.83±0.33 and osteoporosis at femoral neck (51.6%) with T-score mean ±SD-3.36±-0.67. Pearsons correlation coefficient test showed inverse relationship between age and BMD both lumbar spine (r = -0.301, p = 0.003) and femoral neck (r = -0.303, p=0.003) whereas the positive relation between BMI and BMD both at lumbar spine (r=0.338, p=0.001) and femoral neck (r =0.343, p=0.001). These showed that with advancing age, BMD decreases and the risk of osteoporosis increases and with increasing BMI, BMD increases and risk of osteoporosis decreases.Conclusion: The findings of this study portrait that aging and low BMI are risk factors associated with bone loss. So preventive measure should be taken for high risk post menopausal women.Bangladesh J. Nuclear Med. 17(2): 138-141, July 2014

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Head-to-head comparisons of bisphosphonates and teriparatide in osteoporosis: a meta-analysis

Clinical & Investigative Medicine ◽

10.25011/cim.v40i3.28394 ◽

2017 ◽

pp. E146-E157 ◽

Cited By ~ 17

Author(s):

Chun-Lin Liu ◽

Han-Chung Lee ◽

Chun-Chung Chen ◽

Der-Yang Cho

Keyword(s):

Lumbar Spine ◽

Femoral Neck ◽

Treatment Effectiveness ◽

Meta Analysis ◽

Mineral Density ◽

Total Hip ◽

Nonvertebral Fractures ◽

Post Menopausal Osteoporosis ◽

Significant Difference ◽

Post Menopausal

Purpose: This meta-analysis aimed to compare the efficacy and safety of teriparatide vs. bisphosphonates in the management of osteoporosis. Methods: A total of 1,967 patients from eight randomized controlled trials were analyzed; outcomes included bone mineral density (BMD) of the femoral neck, total hip and lumbar spine, vertebral and nonvertebral fractures and any adverse event. A subgroup analysis of treatment effectiveness was performed according to the etiology of osteoporosis; i.e., glucocorticoid-induced osteoporosis (GIO) vs. post-menopausal osteoporosis (PO). Results: Teriparatide increased the BMD of the lumbar spine, femoral neck and total hip to a greater extent than bisphosphonates. Patients treated with teriparatide also had a lower risk of vertebral fractures compared with bisphosphonates; however, no difference in risk of nonvertebral fractures (or adverse events) was found. GIO subgroups showed larger increases in BMD of the lumbar spine, total hip and femoral neck in patients treated with teriparatide compared with bisphosphonates. The PO subgroup showed larger increases in BMD of the lumbar spine in patients treated with teriparatide compared with bisphosphonates. Patients in the GIO subgroup (but not the PO subgroup) were less likely to suffer a vertebral fracture on teriparatide as compared with bisphosphonates. In contrast, no significant difference in the percentage of nonvertebral fractures was noted between the two types of treatment for either subgroup. Conclusion: Teriparatide significantly increased the BMD of lumbar spine, total hip and femoral neck, particularly in GIO-induced osteoporosis. Teriparatide did not lower the risk of nonvertebral fractures when compared with bisphosphonates.

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Breast Safety and Efficacy of Genistein Aglycone for Postmenopausal Bone Loss: A Follow-Up Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2008-1087 ◽

2008 ◽

Vol 93 (12) ◽

pp. 4787-4796 ◽

Cited By ~ 94

Author(s):

Herbert Marini ◽

Alessandra Bitto ◽

Domenica Altavilla ◽

Bruce P. Burnett ◽

Francesca Polito ◽

...

Keyword(s):

Bone Mineral Density ◽

Lumbar Spine ◽

Femoral Neck ◽

Postmenopausal Women ◽

Sister Chromatid ◽

Safety Profile ◽

Sister Chromatid Exchange ◽

Endometrial Thickness ◽

Mineral Density ◽

Brca1 And Brca2

Context: Genistein aglycone improves bone metabolism in women. However, questions about the long-term safety of genistein on breast as well as its continued efficacy still remain. Objective: We assessed the continued safety profile of genistein aglycone on breast and endometrium and its effects on bone after 3 yr of therapy. Design: The parent study was a randomized, double-blind, placebo-controlled trial involving 389 osteopenic, postmenopausal women for 24-months. Subsequently, a subcohort (138 patients) continued therapy for an additional year. Patients and Interventions: Participants received 54 mg of genistein aglycone daily (n = 71) or placebo (n = 67). Both treatment arms received calcium and vitamin D3 in therapeutic doses. Main Outcomes: Mammographic density was assessed at baseline, 24 and 36 months by visual classification scale and digitized quantification. BRCA1 and BRCA2, sister chromatid exchange, and endometrial thickness were also evaluated. Lumbar spine and femoral neck bone mineral density were also assessed. Secondary outcomes were biochemical levels of bone markers. Results: After 36 months, genistein did not significantly change mammographic breast density or endometrial thickness, BRCA1 and BRCA2 expression was preserved, whereas sister chromatid exchange was reduced compared with placebo. Bone mineral density increases were greater with genistein for both femoral neck and lumbar spine compared to placebo. Genistein also significantly reduced pyridinoline, as well as serum carboxy-terminal cross-linking telopeptide and soluble receptor activator of NF-κB ligand while increasing bone-specific alkaline phosphatase, IGF-I, and osteoprotegerin levels. There were no differences in discomfort or adverse events between groups. Conclusions: After 3 yr of treatment, genistein exhibited a promising safety profile with positive effects on bone formation in a cohort of osteopenic, postmenopausal women.

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Vitamin D deficiency as a risk factor for thyroid cancer: A meta-analysis of case-control studies

Nutrition ◽

10.1016/j.nut.2018.04.015 ◽

2019 ◽

Vol 57 ◽

pp. 5-11 ◽

Cited By ~ 12

Author(s):

Junyu Zhao ◽

Haipeng Wang ◽

Zhongwen Zhang ◽

Xiaojun Zhou ◽

Jinming Yao ◽

...

Keyword(s):

Vitamin D ◽

Risk Factor ◽

Thyroid Cancer ◽

Vitamin D Deficiency ◽

Meta Analysis ◽

Case Control ◽

Case Control Studies

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Fermented Milk Products and Bone Health in Postmenopausal Women: A Systematic Review of Randomized Controlled Trials, Prospective Cohorts, and Case-Control Studies

Advances in Nutrition ◽

10.1093/advances/nmz108 ◽

2019 ◽

Cited By ~ 1

Author(s):

Angel M Ong ◽

Kai Kang ◽

Hope A Weiler ◽

Suzanne N Morin

Keyword(s):

Hip Fracture ◽

Postmenopausal Women ◽

Bone Health ◽

Meta Analysis ◽

Fermented Milk ◽

Case Control ◽

Case Control Studies ◽

T Score ◽

Randomized Controlled ◽

Prospective Cohorts

ABSTRACT Milk and milk product consumption is positively associated with bone mineral density (BMD). Emerging evidence suggests that fermented milk products (FMPs) may have specific beneficial effects on skeletal health. We conducted a systematic review and meta-analysis to assess the effect of FMPs on bone health indicators in postmenopausal women given their increased risk for osteoporosis and fragility fractures. Electronic databases were searched for randomized controlled trials (RCTs) and prospective cohort and case-control studies that examined the relation between FMPs and bone health outcomes (fracture incidence, BMD, BMD T-score, and percentage change in bone turnover markers) in postmenopausal women. Two reviewers independently conducted abstract and full-text screenings and data extractions. Risk of bias was assessed using the RoB 2.0 tool and the Newcastle–Ottawa scale for interventional and observational studies. Pooled RRs were obtained using a random-effects model by the DerSimonian–Laird method. Three RCTs, 3 prospective cohorts, and 3 case-control studies met the inclusion criteria. Results of the meta-analysis of 3 cohort studies (n = 102,819) suggest that higher yogurt consumption was associated with reduced hip fracture risk (pooled RR: 0.76; 95% CI: 0.63, 0.92, I2 = 29%), but no difference in hip fracture risk was found between higher and lower cheese consumption (pooled RR: 0.89; 95% CI: 0.73, 1.10, I2 = 0%). Case-control studies revealed that cheese intake had either a null or a protective effect against osteoporosis (BMD T-score ≤−2.5). Daily yogurt or cheese intervention (<2 mo) decreased bone resorption marker concentrations, but had no effect on bone formation markers. In postmenopausal women, of the FMPs studied, only greater yogurt consumption was associated with a reduced risk of hip fracture compared with low or no intake. Daily cheese intake may be associated with higher BMD T-scores, but evidence was limited. Additional and longer-term trials examining these relations are warranted.

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Relation between intima-media thickness and bone mineral density in postmenopausal women: a cross-sectional study

Sao Paulo Medical Journal ◽

10.1590/s1516-31802011000300004 ◽

2011 ◽

Vol 129 (3) ◽

pp. 139-145 ◽

Cited By ~ 9

Author(s):

Daniela Fodor ◽

Cosmina Bondor ◽

Adriana Albu ◽

Laura Muntean ◽

Siao-pin Simon ◽

...

Keyword(s):

Lumbar Spine ◽

Femoral Neck ◽

Postmenopausal Women ◽

Atherosclerotic Plaque ◽

Vertebral Fractures ◽

Mineral Density ◽

Cross Sectional ◽

T Score ◽

Osteoporotic Vertebral Fractures ◽

The Relationship

CONTEXT AND OBJECTIVES: Controversy exists regarding the relationship between atherosclerosis and osteoporosis. The aim of this study was to determine the relationship between intima-media thickness (IMT) of the common carotid artery (CCA), presence of calcified atherosclerotic plaques and bone mineral density (BMD) evaluated by dual energy X-ray absorptiometry (DXA), in postmenopausal women. DESIGN AND SETTING: Cross-sectional study at Second Internal Medicine Clinic, Cluj-Napoca, Romania. METHODS: We studied the IMT (left and right CCA and mean IMT) and T-score (lumbar spine L2-L4, femoral neck and total hip) in 100 postmenopausal women (mean age 64.5 years). The presence of calcified atherosclerotic plaque and osteoporotic vertebral fractures was also noted. RESULTS: IMT in the left and right CCA and mean IMT were significantly associated with T-score measured for the lumbar spine L2-L4, femoral neck and total hip, with lower T-score, in the osteoporotic group than in the normal and osteopenic groups (P < 0.05). IMT had a significantly negative correlation with the lumbar spine T-score and femoral neck T-score; and mean IMT with lowest T-score. Mean IMT (P < 0.001), high blood pressure (P = 0.005) and osteoporotic vertebral fractures (P = 0.048) showed statistical significance regarding the likelihood of developing atherosclerotic plaque. CONCLUSIONS: In women referred for routine osteoporosis screening, the relationship between CCA, atherosclerosis and osteoporosis can be demonstrated using either cortical or trabecular BMD. Vertebral fractures may be considered to be a likelihood factor for atherosclerotic plaque development.

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Bone Mineral Density across the Lifespan in Patients with Type 1 Diabetes

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz153 ◽

2019 ◽

Vol 105 (3) ◽

pp. 746-753 ◽

Cited By ~ 4

Author(s):

Eitan Halper-Stromberg ◽

Tyler Gallo ◽

Anagha Champakanath ◽

Iman Taki ◽

Marian Rewers ◽

...

Keyword(s):

Bone Mineral Density ◽

Body Mass Index ◽

Type 1 Diabetes ◽

Lumbar Spine ◽

Femoral Neck ◽

Postmenopausal Women ◽

Age Groups ◽

Mineral Density ◽

Age And Sex

Abstract Context Fracture risk in people with type 1 diabetes (T1D) is higher than their peers without diabetes. Objective To compare bone mineral density (BMD) across the lifespan in individuals with T1D and age- and sex-matched healthy controls. Design Cross-sectional. Setting Subjects (5–71 years) with T1D and matched controls from ongoing research studies at Barbara Davis Center for Diabetes. Patients or other participants Participants with lumbar spine BMD by dual X-ray absorptiometry (DXA) were divided into 2 groups: children ≤20 years and adults >20 years. Intervention None. Main outcome measures Comparison of BMD by diabetes status across age groups and sex using a linear least squares model adjusted for age and body mass index (body mass index (BMI) for adults; and BMI z-score in children). Results Lumbar spine BMD from 194 patients with T1D and 156 controls were analyzed. There was no difference in age- and BMI-adjusted lumbar spine BMD between patients with T1D and controls: among male children (least squares mean ± standard error of the mean [LSM ± SEM]; 0.80 ± 0.01 vs 0.80 ± 0.02 g/cm2, P = .98) or adults (1.01 ± 0.03 vs 1.01 ± 0.03 g/cm2, P = .95), and female children (0.78 ± 0.02 vs 0.81 ± 0.02 g/cm2, P = .23) or adults (0.98 ± 0.02 vs 1.01 ± 0.02 g/cm2, P = .19). Lumbar spine (0.98 ± 0.02 vs 1.04 ± 0.02 g/cm2, P = .05), femoral neck (0.71 ± 0.02 vs 0.79 ± 0.02 g/cm2, P = .003), and total hip (0.84 ± 0.02 vs 0.91 ± 0.02, P = .005) BMD was lower among postmenopausal women with T1D than postmenopausal women without diabetes. Conclusion Across age groups, lumbar spine BMD was similar in patients with T1D compared with age- and sex-matched participants without diabetes, except postmenopausal females with T1D had lower lumbar spine, femoral neck, and total hip BMD.

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The Effect of Kinesitherapy on Bone Mineral Density in Primary Osteoporosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/5074824 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Shanxi Wang ◽

Shuzhen Li ◽

Xing Xie ◽

Juying Xie

Keyword(s):

Lumbar Spine ◽

Femoral Neck ◽

Controlled Trial ◽

Meta Analysis ◽

Cochrane Library ◽

Primary Osteoporosis ◽

Mineral Density ◽

Age Related ◽

Positive Effect ◽

Quality Evidence

Objective. Osteoporosis (OP) is a well-established age-related disease, pathologically characterized by bone microarchitectural deterioration, increased fragility, and low BMD. Primary osteoporosis (POP) is the most common type of OP. Methods. Publications pertaining to the effectiveness of kinesitherapy on BMD in POP from PubMed, SCI, Cochrane Library, Embase, VIP, CNKI, and Wanfang Database were retrieved from their inception to October 2019. Results. A total of 21 studies with 1840 participants were included. The results of the meta-analysis revealed that kinesitherapy plus antiosteoporosis medications had a positive effect on lumbar spine BMD when the duration of intervention was 6 months (MD = 0.11 g/cm2; 95% CI: 0.06–0.15; P<0.0001) or >6 months (MD = 0.04 g/cm2; 95% CI: 0.02–0.06; P<0.0001) compared with antiosteoporosis medications alone. Additional kinesitherapy plus antiosteoporosis medications were associated with improved femoral neck BMD compared with antiosteoporosis medications alone (MD = 0.09 g/cm2; 95% CI: 0.03–0.16; P=0.004). Conclusions. Kinesitherapy plus antiosteoporosis medications significantly improved lumbar spine and femoral neck BMD in the current low-quality evidence. Additional high-quality evidence is required to confirm the effect of kinesitherapy on BMD in patients with POP.

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