New Study Links Popular Thyroid Drug to Increased Bone Loss

In particular, osteoblasts secrete RANKL (receptor activation for nuclear factor kB ligand) and CSF1 (colony-stimulating factor 1), and other factors such as cytokines, prostaglandins, and growth factor that regulate bone resorption and are crucial for osteoclastogenesis 29. The most important stimulator of osteoclastic formation is RANKL, a member of the Tumor Necrosis Factor (TNF) protein superfamily. All factors involved in osteoclast genesis stimulate RANKL by osteoblastic cell lines. Osteoclastic formation is inhibited by osteoprotegerin (OPG), which is a soluble receptor for RANKL, thereby preventing interaction of RANKL with its receptor RANK, a member of the TNF receptor family 30. In our study, in untreated hypothyroid patients (Group A), osteoporosis was not frequently evident.

The influence of subclinical hyperthyroidism on bone

Similar data have been reported in pre- and postmenopausal women with subclinical hyperthyroidism caused by multinodular goiter. BMD and bone turnover markers were decreased and respectively higher in post- than in premenopausal ones 51. National Health and Nutrition Examination Survey (NHANES III) showed an association between low serum TSH and osteopenia and osteoporosis. Interestingly, a graded increase in BMD with increased serum TSH across the normal range was observed in healthy American women of both black and white races 52.

Underactive thyroid (hypothyroidism)

• These data would suggest that the skeletal abnormalities found in hypothyroidism are independent of systemic TSH.
• Aaron Schulman, MD, an assistant professor of endocrinology at Weill Cornell Medical College who was not on the research team, told Health that the trial was well designed.
• But evidence indicates that osteoporosis can begin early in life and it’s yet another reason to feed ourselves and our children well, with lots of bone-strengthening, whole foods that will lay a foundation for a lifetime of structure.
• Its direct action on bone tissue cells leads to enhanced bone remodeling and osteoporosis 15,16.
• Correct development, achievement of peak bone mass and normal functioning of human skeleton depend on different factors.

If material is not included in the chapter’s Creative Commons license and your intended dayquil synthroid use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. But if you’re concerned about taking levothyroxine, experts suggest speaking to your doctor before making any changes.

Hyperthyroidism is a common pathology, with a prevalence of 2% in women and 0.2% in men. Despite treatment, in the long term, the mortality rate increases in this latter population to 2.9% as a result of the aftermath of femoral neck fractures (20). In a review of the impact of hyperthyroidism on bone, it was noted that 8% of patients had symptomatic bone disease, all women, mostly postmenopausal, of whom 65% had severe bone pain or evidence of fractures and up to 75% had been thyrotoxic for less than 1 year (28–32). Early studies reported a negative effect on bone metabolism with a reduced bone mass in patients on prolonged L-T4 treatment with reduced serum TSH 74,75,76, as reported in Table 3.

Toxic multinodular goiter is the most frequent cause of spontaneous hyperthyroidism in areas with a low iodine intake and hyperthyroidism may also be precipitated by excess iodine intake from drugs or radiographic contrast agents. Overt thyroid disorders, defined as a suppression of TSH with increased FT4 and/or free triiodothyronine (FT3) are clinically evident and an early diagnosis is usually made. Due to its deleterious effect on the cardiovascular system 35, treatment of hyperthyroidism is always necessary to ensure a rapid relief of symptoms and to avoid long-term consequences. For these reasons, severe long-lasting hyperthyroidism is now rarely encountered in clinical practice.

Doctors are less concerned about bone loss in premenopausal women who take levothyroxine and have normal thyroid hormone levels, Schulman said. That’s because people who’ve gone through menopause may have more bone loss to begin with due to lower estrogen levels. Our results indicated no significant relationship between the daily levothyroxine dose and fracture risk in non-severe osteoporosis patients. When we calculated the appropriate sample size assuming 80% power, 5% alpha-error, and a 3% expected fracture incidence in unexposed group, 1492 patients were required to confirm a relative risk of 2.0. In our study, the minimum number of participants in 1 comparison was 1565 patients in the non-severe osteoporosis subgroup. Therefore, the number of participants in this study’s subgroup analyses was sufficient to examine the relationship between the daily levothyroxine dose and fracture risk.

No effect of prolonged L-T4 treatment on bone mass was observed in premenopausal women with reduced serum TSH in a meta-analysis report, whereas postmenopausal women with subclinical hyperthyroidism due to TSH-suppressive doses of L-T4 had reduced bone mass 80. Lack of effect on BMD of long-term therapy with L-T4 TSH suppressive for DTC was also reported both in premenopausal and postmenopausal women 83. Studies in young patients with exogenous subclinical hyperthyroidism have been reported to have no effect on peak bone mass 84. Overall, the available evidences suggest that premenopausal women on chronic TSH suppressive treatment with L-T4 do not have adverse effect on BMD. On the contrary, postmenopausal women on TSH suppressive doses of L-T4 are at risk of bone loss, particularly, when osteopenia or osteoporosis are already present. Finally, a very recent meta-analysis study on the influence of TSH suppression on BMD in patients with DTC suggested a possible association between L-T4-mediated TSH suppression and the lower BMD in postmenopausal women, but not in premenopausal women and men 86.

• However, in another study it has been confirmed that patients treated to maintain the euthyroid preserved bone density in the spine and hip, compared to untreated patients who suffered a 2% annual decline (19).
• If your bone density is actually low, there are many therapies out there to treat osteoporosis.
• 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.
• But if you heed the suggestions below, you may see much better outcomes and the ability to leave the “porous” to the pumice stone.
• High-impact exercise, such as running or power walking, helps strengthen bones.

“Levothyroxine remains the safest and most widely used option to treat underactive thyroid,” he said. He added that other options may come with an even higher risk of bone loss, especially in older adults. Participants had at least two doctor visits, during which blood work confirmed that they had normal levels of both thyroid-stimulating hormone (TSH), which measures the hormone in the brain that regulates thyroid function, and free T4, which reflects levels of thyroxine. Doctors prescribe levothyroxine to treat hypothyroidism, which occurs when the thyroid gland produces too little thyroxine. Without treatment, weight gain, fatigue, hair loss, and more serious complications can occur. You can also have too much thyroxine, which has been linked with bone fractures.

Other methods include quantitative computed tomography (QCT), which is likely more accurate than DXA. Osteoporosis is a major cause of disability in human, while it is actually treatable. Thyroid disorders are one of the major common disorders which may affect the bone density. For all these reasons we decided to estimate the prevalence of osteoporosis in patients treated with thyroid hormone, considering such factors as the dose of thyroxin and thyrotropin levels, as well as the treatment time. There is a high prevalence of bone loss in patients with subclinical hypothyroidism treated with exogenous thyroxin.

A case-control study from Denmark, where all 124,655 patients with a fracture served as cases and 373,962 randomly selected age- and gender-matched people without fractures served as controls, found no association between LT4 treatment and risk of fracture 24. An analysis of 23,183 LT4 users from the UK General Practice Research Database (i.e. managed in the primary care setting) also found no significant association between LT4 use and fracture risk overall although there was an apparent increased risk in males 25. Other observational data also did not identify a significant effect of LT4 treatment on bone health 26. Overt hypothyroidism occurs when both the thyroid hormone level (usually FT4) is low and the TSH level is high.