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April 27, 1994, Vol 271, No. 16 >
ARTICLE | April 27, 1994

Thyroid Hormone, Osteoporosis, and Estrogen FREE

David S. Cooper, MD
[+] Author Affiliations

Reprint requests to Division of Endocrinology, Sinai Hospital of Baltimore, Belvedere at Greenspring, Baltimore, MD 21215 (Dr Cooper).


JAMA. 1994;271(16):1283-1284. doi:10.1001/jama.1994.03510400069035
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References

As noted by Schneider and colleagues1 in this issue of THE JOURNAL, thyroid hormone (levothyroxine sodium) is one of the most frequently prescribed drugs in the United States. Postmenopausal women are particularly prone to develop hypothyroidism, thyroid nodules, and thyroid cancers and are therefore far more likely than men to be taking thyroid hormone, either for replacement therapy or suppression therapy.2 Unfortunately, older women are also at high risk for progressive bone loss from thyroid hormone, as documented in a number of previous studies and summarized in the article by Schneider et al.1 The risk of bone loss is greatest in those women taking larger thyroid hormone doses and seems to be minimal in women taking more modest doses.1 Although the degree of skeletal demineralization observed in many studies places some patients below the fracture threshold in terms of their bone density, no study to date

REFERENCES

1 +
Schneider DL, Barrett-Connor EL, Morton DJ.  Thyroid hormone use and bone mineral density in elderly women: effects of estrogen. JAMA . 1994;;271:1245-1249.
2 +
Kaufman SC, Gross TP, Kennedy DL.  Thyroid hormone use: trends in the United States from 1960 through 1988. Thyroid . 1991;;1:285-291.
3 +
Solomon BL, Wartofsky L, Burman K.  Prevalence of fractures in postmenopausal women with thyroid disease. Thyroid . 1993;;3:17-23.
4 +
Carr D, McLeod DT, Parry G, Thornes HM.  Fine adjustment of thyroxine replacement dosage: comparison of the thyrotrophin releasing hormone test using a sensitive thyrotrophin assay with measurement of free thyroid hormones and clinical assessment. Clin Endocrinol (Oxf) . 1988;;28:325-333.
5 +
Nicoloff JT, Spencer CA.  The use and misuse of the sensitive thyrotropin assays. J Clin Endocrinol Metab . 1990;;71:553-558.
6 +
Mandel SJ, Brent GA, Larsen PR.  Levothyroxine therapy in patients with thyroid disease. Ann Intern Med . 1993;;119:492-502.
7 +
Diamond T, Nery L, Hales I.  A therapeutic dilemma: suppressive doses of thyroxine significantly reduce bone mineral measurements in both premenopausal and postmenopausal women with thyroid carcinoma. J Clin Endocrinol Metab . 1990;;72: 1184-1188.
8 +
Watts NB.  Use of a sensitive thyrotropin assay for monitoring treatment with levothyroxine. Arch Intern Med . 1989;;149:309-312.
9 +
Gharib H, James EM, Charboneau JQ, Naessens JM, Offord KP, Gorman CA.  Suppressive therapy with levothyroxine for solitary thyroid nodules. N Engl J Med . 1987;;317:70-75.
10 +
Sawin CT, Herman T, Molitch ME, London MH, Kramer SM.  Aging and the thyroid. Am J Med . 1983;;75:206-209.
11 +
Ross DS, Daniels GH, Gouveia D.  The use and limitations of a chemiluminescent thyrotropin assay as a single thyroid function test in an outpatient endocrine clinic. J Clin Endocrinol Metab . 1990;;71:764-769.
12 +
Biondi B, Fazio S, Carella C, et al.  Cardiac effects of long-term thyrotropin-suppression with levothyroxine. J Clin Endocrinol Metab . 1993;;77:334-338.
13 +
Rosen H, Moses AC, Gundberg C, et al.  Therapy with parenteral pamidronate prevents thyroid hormone-induces bone turnover in humans. J Clin Endocrinol Metab . 1993;;77:664-669.
14 +
Ongphiphadhanakul B, Alex S, Braverman LE, Baran DT.  Excessive L-thyroxine therapy decreases femoral bone mineral densities in the male rat: effect of hypogonadism and calcitonin. J Bone Miner Res . 1992;;7:1227-1231.

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1 +
Schneider DL, Barrett-Connor EL, Morton DJ.  Thyroid hormone use and bone mineral density in elderly women: effects of estrogen. JAMA . 1994;;271:1245-1249.
2 +
Kaufman SC, Gross TP, Kennedy DL.  Thyroid hormone use: trends in the United States from 1960 through 1988. Thyroid . 1991;;1:285-291.
3 +
Solomon BL, Wartofsky L, Burman K.  Prevalence of fractures in postmenopausal women with thyroid disease. Thyroid . 1993;;3:17-23.
4 +
Carr D, McLeod DT, Parry G, Thornes HM.  Fine adjustment of thyroxine replacement dosage: comparison of the thyrotrophin releasing hormone test using a sensitive thyrotrophin assay with measurement of free thyroid hormones and clinical assessment. Clin Endocrinol (Oxf) . 1988;;28:325-333.
5 +
Nicoloff JT, Spencer CA.  The use and misuse of the sensitive thyrotropin assays. J Clin Endocrinol Metab . 1990;;71:553-558.
6 +
Mandel SJ, Brent GA, Larsen PR.  Levothyroxine therapy in patients with thyroid disease. Ann Intern Med . 1993;;119:492-502.
7 +
Diamond T, Nery L, Hales I.  A therapeutic dilemma: suppressive doses of thyroxine significantly reduce bone mineral measurements in both premenopausal and postmenopausal women with thyroid carcinoma. J Clin Endocrinol Metab . 1990;;72: 1184-1188.
8 +
Watts NB.  Use of a sensitive thyrotropin assay for monitoring treatment with levothyroxine. Arch Intern Med . 1989;;149:309-312.
9 +
Gharib H, James EM, Charboneau JQ, Naessens JM, Offord KP, Gorman CA.  Suppressive therapy with levothyroxine for solitary thyroid nodules. N Engl J Med . 1987;;317:70-75.
10 +
Sawin CT, Herman T, Molitch ME, London MH, Kramer SM.  Aging and the thyroid. Am J Med . 1983;;75:206-209.
11 +
Ross DS, Daniels GH, Gouveia D.  The use and limitations of a chemiluminescent thyrotropin assay as a single thyroid function test in an outpatient endocrine clinic. J Clin Endocrinol Metab . 1990;;71:764-769.
12 +
Biondi B, Fazio S, Carella C, et al.  Cardiac effects of long-term thyrotropin-suppression with levothyroxine. J Clin Endocrinol Metab . 1993;;77:334-338.
13 +
Rosen H, Moses AC, Gundberg C, et al.  Therapy with parenteral pamidronate prevents thyroid hormone-induces bone turnover in humans. J Clin Endocrinol Metab . 1993;;77:664-669.
14 +
Ongphiphadhanakul B, Alex S, Braverman LE, Baran DT.  Excessive L-thyroxine therapy decreases femoral bone mineral densities in the male rat: effect of hypogonadism and calcitonin. J Bone Miner Res . 1992;;7:1227-1231.

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