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Published on: February 3, 2023
99Tc-MDP maintains bone mineral density for postmenopausal differentiated thyroid cancer patients with osteopenia
Yuanfang Zhang1, Yingqiu Wang2, Donghua Sun1,2
1Department of Nuclear Medicine and Neurology, Tenth People's Hospital of Tongji University, Shanghai, China.
Background:
The main determinant of skeletal fragility in postmenopausal patients with differentiated thyroid cancer (DTC) and osteopenia is thyroid-stimulating hormone (TSH) suppressive therapy. Evidence for the use of bisphosphonates, including technetium-99 methylene diphosphonate (99Tc-MDP), in this clinical setting remains limited.
Objective:
To investigate the effects of 99Tc-MDP on osteopenia (T-score <-1.0≥-2.5 SD for the lumbar spine by DXA) in postmenopausal women with DTC under TSH suppression therapy compared with routine calcium/vitamin D supplementation.
Methods:
A total of 102 postmenopausal patients with DTC and osteopenia under TSH suppression therapy were enrolled in this open-label, prospective study. Patients were divided into two groups: calcium/vitamin D supplements (groupCa) and calcium/vitamin D plus 99Tc-MDP (groupmdp) groups. Lumbar spine bone mineral density (BMD) by DXA was measured before and 12 months after treatment. Bone turnover markers were evaluated at baseline, 6 months, and 12 months.
Results:
The combined 99Tc-MDP treatment significantly increased the mean percentage change of lumbar BMD at month 12 compared with groupCa (t=2.156, p=0.035). A significant decrease in BMD of the lumber spine from 0.9148 ± 0.08 to 0.8726 ± 0.08 (t=3.81, p=0.001) at month 12 was observed in groupCa. The mean percentage change from baseline in the levels of serum β-isomer of C-terminal telopeptide of type I collagen (β-CTX), procollagen type 1 N-terminal propeptide (P1NP) showed that 99Tc-MDP combined treatment significantly increased PINP at month 6 (t=2.37, p = 0.02) and 12 (t=2.224, p = 0.029), and significantly decreased β-CTX at month 12 (t=-2.746, p = 0.008) compared with groupCa. No severe adverse events were reported in either group.
Conclusions:
99Tc-MDP is safe and could maintain lumbar BMD in postmenopausal women with DTC and osteopenia under TSH suppression therapy during a 1-year follow-up. Calcium/vitamin D supplementation alone did not effectively prevent bone loss in these patients.
Trial Registration Number:
ChiCTR2200064170.
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