Receptor activator of nuclear factor kappaB ligand and osteoprotegerin in men with thyroid cancer.
BACKGROUND
Suppressive thyroid hormone therapy is generally a lifelong treatment for patients with differentiated thyroid cancer (DTC). However, long-standing thyrotropin (TSH) suppression is a risk factor for osteoporosis. Osteoprotegerin (OPG) and receptor activator of nuclear factor kappaB ligand (RANKL) are central regulators of bone turnover. The aim was to analyze the effects of a suppressive thyroid hormone therapy in males with DTC on the OPG/RANKL system and on bone metabolism.


METHODS
The OPG and soluble RANKL (sRANKL) were determined in 40 men (mean age, 53.2 years) with DTC on suppressive thyroid hormone therapy (TSH; 0.053 +/- 0.037 mU L(-1), duration 5.7 +/- 4.4 years) and 120 healthy controls matched for age. The markers of bone metabolism were C-terminal telopeptide of type I collagen in serum (sCTx) and osteocalcin (OC).


RESULTS
The control group had OPG values (mean +/- SD) of 1.9 +/- 1.0 pmol L(-1) and sRANKL values of 0.40 +/- 0.62 pmol L(-1). In patients with DTC, results for OPG were 3.03 +/- 1.04 pmol L(-1) (P < 0.05) and for sRANKL were 0.13 +/- 0.16 pmol L(-1) (P < 0.05). The control group presented values for sCTx of 2669 +/- 1132 pmol L(-1) and for OC of 17.89 +/- 6.5 ng mL(-1). Patients with DTC on suppressive thyroid hormone therapy had increased sCTx values of 3810 +/- 2020 pmol L(-1) (P = 0.03) but comparable OC values of 19.21 +/- 7.67 ng mL(-1) (NS).


CONCLUSIONS
Suppressive thyroid hormone therapy in men with DTC increased bone degradation and induced significant changes in the OPG/RANKL system. These changes include, besides the risk of osteoporosis, possible negative effects on the vascular function and an increased risk of cardiovascular disease.
Mikosch
P
P
Department of Nuclear Medicine and Special Endocrinology, Klagenfurt State Hospital, Klagenfurt, Austria. peter.mikosch@lkh-klu.at
Igerc
I
I
Kudlacek
S
S
Woloszczuk
W
W
Gallowitsch
H J
HJ
Kresnik
E
E
Stettner
H
H
Grimm
G
G
Lind
P
P
Pietschmann
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001842:Bone and Bones / Q000378:metabolism; D024042:Collagen Type I / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D053244:Osteoprotegerin / Q000097:blood*; D010455:Peptides / Q000097:blood; D053245:RANK Ligand / Q000097:blood*; D013964:Thyroid Neoplasms / Q000097:blood* / Q000188:drug therapy; D013972:Thyrotropin / Q000097:blood / Q000627:therapeutic use
D015415:Biomarkers; D024042:Collagen Type I; D053244:Osteoprotegerin; D010455:Peptides; D053245:RANK Ligand; C052929:collagen type I trimeric cross-linked peptide; D015675:Osteocalcin; D013972:Thyrotropin