[Osteoporosis treatment in patients with hyperthyroidism].
Childhood thyroid hormone (T3) is essential for the normal development of endochondral and intramembranous bone and plays an important role in the linear growth and maintenance of bone mass. In adult, T3 stimulates osteoclastic bone resorption mediated primarily by TR alpha and local conversion by deiodinase D2 may play a role in local activation. TSH seems to be an inhibitor of bone resorption and formation. In thyrotoxicosis patients with Graves' disease, there is increased bone remodelling, characterized by an imbalance between bone resorption and formation, which results in a decrease of bone mineral density (BMD) and an increased risk for osteoporotic fracture. Antithyroid treatment is able to reduce dramatically the bone resorption and to normalize BMD reduction. But previous hyperthyroidism is independently associated with an increased risk for fracture. Although further studies relating to the mechanism for possible impaired bone strength in these patients will be needed, bisphosphonates may be beneficial treatment for prevention of bone fractures in patients with severe risk for fractures, such as post-menopausal women.
Department of Endocrinology and Metabolism, Internal Medicine, Yokohama Rosai Hospital.
Jun
J
Saito
Tetsuo
T
Nishikawa
D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D016723:Bone Remodeling; D001842:Bone and Bones / Q000378:metabolism; D002118:Calcium / Q000378:metabolism; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications* / Q000378:metabolism / Q000628:therapy; D010024:Osteoporosis / Q000188:drug therapy / Q000209:etiology*; D011988:Receptors, Thyroid Hormone / Q000502:physiology; D013963:Thyroid Hormones / Q000502:physiology; D013971:Thyrotoxicosis / Q000150:complications / Q000378:metabolism
D050071:Bone Density Conservation Agents; D011988:Receptors, Thyroid Hormone; D013963:Thyroid Hormones; D002118:Calcium