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Negative correlation between bone mineral density and TSH receptor antibodies in male patients with untreated Graves'
1Department of Endocrinology and Metabolism, Rakuwakai Otowa Hospital, Kyoto, Japan.
Insights
Male Graves' disease patients show reduced bone mineral density (BMD), particularly cortical bone loss, especially in older individuals. Monitoring BMD at the lumbar spine, femoral neck, and distal radius is crucial for fracture prevention.
Area of Science:
- Endocrinology
- Bone Metabolism
- Geriatric Medicine
Background:
- Hyperthyroidism is linked to reduced bone mineral density (BMD) and increased bone resorption in women.
- Data on bone health in male hyperthyroid patients is limited.
- Graves' disease is a common cause of hyperthyroidism.
Purpose of the Study:
- To evaluate bone mineral density (BMD) and bone metabolism in male patients with Graves' disease.
- To compare BMD in male Graves' disease patients with healthy male controls.
- To identify factors associated with bone loss in these patients.
Main Methods:
- Dual-energy x-ray absorptiometry (DXA) was used to measure BMD.
- BMD was assessed at the lumbar spine, femoral neck, and distal radius.
- Study included 56 male Graves' disease patients and 34 male controls.
Main Results:
- Male Graves' disease patients had significantly lower BMD and T-scores at the lumbar spine and distal radius compared to controls.
- Z-scores were significantly lower at all measured sites in patients.
- Distal radius Z-scores correlated negatively with age, free thyroxine, and bone turnover markers.
Conclusions:
- Male Graves' disease patients exhibit a high prevalence of cortical bone loss, particularly elderly individuals.
- BMD measurement is essential for all Graves' disease patients, irrespective of gender.
- Monitoring BMD at the lumbar spine, femoral neck, and distal radius is recommended for fracture prevention.
Introduction:
Although it has been established that hyperthyroidism leads to reduced bone mineral density (BMD), with accelerated bone turnover promoting bone resorption in female patients, there is a dearth of data for male patients with hyperthyroidism. This study evaluated BMD and bone metabolism in male patients with Graves' disease.
Methods:
The study included 56 Japanese male patients with newly diagnosed Graves' disease and 34 normal Japanese male control subjects of similar age and body mass index. We used dual energy x-ray absorptiometry to measure BMD at sites with different cortical/cancellous bone ratios (lumbar spine, femoral neck, and distal radius).
Results:
At the lumbar spine and the distal radius, BMD and T-scores were significantly lower for patients than for controls. At the femoral neck, on the other hand, the same values were relatively, but not significantly, lower in patients than in controls. However, Z-scores at all three sites were significantly lower for patients than for controls. The Z -score at the distal radius of patients was significantly lower than that at their lumbar spine and femoral neck. In addition, Z-score at the distal radius correlated negatively with age, free thyroxine, thyroid stimulating hormone receptor antibodies, thyroid stimulating antibody, and urinary N-terminal telopeptide of type I collagen normalized by creatinine.
Conclusions:
These results indicate a high prevalence of cortical bone loss in male patients with Graves' disease, especially elderly patients. We conclude that BMD measurement is crucial in all Graves' disease patients regardless of their gender and that the radial BMD as well as BMD at the lumbar spine and femoral neck should be monitored to effectively prevent bone loss and subsequent fracture.
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