The Effect of Thyroid Hormone on Skeletal Integrity

The Effect of Thyroid Hormone on Skeletal Integrity

Susan L. Greenspan, MD; and
Francis S. Greenspan, MD

From Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; and the University of California, San Francisco, California.

Abstract

Background: Thyroid disease and osteoporosis are common problems often managed by primary care physicians. Despite many studies, confusion still exists about the effect of thyroid hormone on skeletal health.

Purpose: To review evidence on the effect of thyroid hormone (from hyperthyroidism, exogenous or endogenous suppression of thyroid-stimulating hormone [TSH], and thyroid hormone replacement therapy) on skeletal integrity.

Data Sources: A MEDLINE search of papers published between 1966 and 1997.

Data Selection: Cross-sectional studies, longitudinal studies, and meta-analyses that had appropriate control groups (patients matched for age, sex, and menopausal status), made comparisons with established databases, or defined thyroid state by TSH level or thyroid hormone dose were reviewed.

Data Extraction and Synthesis: Data synthesis was not straightforward because of changes in doses and types of thyroid hormone preparations; changes in definitions of thyroid hormone replacement therapy and suppressive therapies; problems with study design; differences in skeletal sites assessed (hip, spine, forearm, or heel) and techniques used to measure bone mineral density; and inclusion of heterogenous and changing thyroid disease states. Overall, hyperthyroidism and use of thyroid hormone to suppress TSH because of thyroid cancer, goiters, or nodules seem to have an adverse effect on bone, especially in postmenopausal women; the largest effect is on cortical bone. Thyroid hormone replacement seems to have a minimal clinical effect on bone.

Conclusion: Women with a history of hyperthyroidism or TSH suppression by thyroid hormone should have skeletal status assessed by bone mineral densitometry, preferably at a site containing cortical bone, such as the hip or forearm.

Article and Author Information

Acknowledgments: The authors thank Dawn Griffiths for assistance with research and preparation of the manuscript.
Grant Support: In part by the Beth Israel Deaconess Medical Center's General Clinical Research Center (National Institutes of Health grant MO1-RR01032).
Requests for Reprints: Susan L. Greenspan, MD, Division of Bone and Mineral Metabolism, Beth Israel Deaconess Medical Center, E/GZ-800, 330 Brookline Avenue, Boston, MA 02215.
Current Author Addresses: Dr. S. Greenspan: Division of Bone and Mineral Metabolism, Beth Israel Deaconess Medical Center, E/GZ-800, 330 Brookline Avenue, Boston, MA 02215.
Dr. F. Greenspan: Division of Endocrinology, Department of Medicine, University of California, 350 Parnassus Avenue, Suite 609, San Francisco, CA 94117.