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Article: Prevention of bone loss induced by thyroxine suppressive therapy in postmenopausal women: The effect of calcium and calcitonin

TitlePrevention of bone loss induced by thyroxine suppressive therapy in postmenopausal women: The effect of calcium and calcitonin
Authors
Issue Date1996
PublisherThe Endocrine Society. The Journal's web site is located at http://jcem.endojournals.org
Citation
Journal Of Clinical Endocrinology And Metabolism, 1996, v. 81 n. 3, p. 1232-1236 How to Cite?
AbstractAlthough controversies exist on the possible adverse effect of T4 on hone mass, most studies reported hone loss in estrogen-deprived postmenopausal women taking suppressive doses of T4. We prospectively studied 46 postmenopausal women with carcinoma of thyroid for 2 yr to evaluate the rate of bone loss and assess whether calcium supplementation with or without intranasal calcitonin was able to decrease the rate of bone loss. All patients were receiving a stable dose of L-T4 (170 ± 60 μg/day or 3.0 ± 1.4 μg/kg · day/for more than 1 yr. All had TSH levels of 0.03 mIU/L or less and an elevated free T4 (FT4) index, but normal T3 levels. The calcium intake was low and averaged 507 ± 384 g/day, as assessed by dietary recall. The subjects were randomized into three groups: 1) intranasal calcitonin (200 IU daily) for 5 days/week plus 1000 mg calcium daily, 2) calcium alone, or 3) placebo. Total body and regional bone mineral density were measured by a dual energy x-ray absorptiometry bone densitometer at 6- month intervals. The results showed that both groups 1 and 2 had stable bone mass, whereas patients in group 3 showed significant bone loss at the end of 2 yr (lumbar spine, 5.0%; hip, 6.7%; trochanter, 4.7%; Ward's triangle, 8.8%; P < 0.05), with hone mineral densities at all four regions lower than those in the other two groups (P < 0.05). There were no differences between groups 1 and 2. All three groups had elevated osteocalcin levels compared with age- matched reference controls. At 1 yr, the osteocalcin level decreased in groups 1 and 2, but remained significantly raised in group 3. No significant changes were detected in the bone-specific alkaline phosphatase levels. Urinary hydroxyproline excretion increased in group 3 at the end of 2 yr, but remained the same in groups 1 and 2. In conclusion, T4-suppressive therapy was associated with bone loss in postmenopausal women, which could be prevented by either calcium supplementation or intranasal calcitonin, although the latter did not provide additional benefit compared to calcium alone. However, careful titration of T4 dosage to maintain biochemical euthyroidism is a better way to avoid the adverse effect of T4 on bone.
Persistent Identifierhttp://hdl.handle.net/10722/49044
ISSN
2015 Impact Factor: 5.531
2015 SCImago Journal Rankings: 2.940
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorKung, AWCen_HK
dc.contributor.authorYeung, SSCen_HK
dc.date.accessioned2008-06-12T06:33:12Z-
dc.date.available2008-06-12T06:33:12Z-
dc.date.issued1996en_HK
dc.identifier.citationJournal Of Clinical Endocrinology And Metabolism, 1996, v. 81 n. 3, p. 1232-1236en_HK
dc.identifier.issn0021-972Xen_HK
dc.identifier.urihttp://hdl.handle.net/10722/49044-
dc.description.abstractAlthough controversies exist on the possible adverse effect of T4 on hone mass, most studies reported hone loss in estrogen-deprived postmenopausal women taking suppressive doses of T4. We prospectively studied 46 postmenopausal women with carcinoma of thyroid for 2 yr to evaluate the rate of bone loss and assess whether calcium supplementation with or without intranasal calcitonin was able to decrease the rate of bone loss. All patients were receiving a stable dose of L-T4 (170 ± 60 μg/day or 3.0 ± 1.4 μg/kg · day/for more than 1 yr. All had TSH levels of 0.03 mIU/L or less and an elevated free T4 (FT4) index, but normal T3 levels. The calcium intake was low and averaged 507 ± 384 g/day, as assessed by dietary recall. The subjects were randomized into three groups: 1) intranasal calcitonin (200 IU daily) for 5 days/week plus 1000 mg calcium daily, 2) calcium alone, or 3) placebo. Total body and regional bone mineral density were measured by a dual energy x-ray absorptiometry bone densitometer at 6- month intervals. The results showed that both groups 1 and 2 had stable bone mass, whereas patients in group 3 showed significant bone loss at the end of 2 yr (lumbar spine, 5.0%; hip, 6.7%; trochanter, 4.7%; Ward's triangle, 8.8%; P < 0.05), with hone mineral densities at all four regions lower than those in the other two groups (P < 0.05). There were no differences between groups 1 and 2. All three groups had elevated osteocalcin levels compared with age- matched reference controls. At 1 yr, the osteocalcin level decreased in groups 1 and 2, but remained significantly raised in group 3. No significant changes were detected in the bone-specific alkaline phosphatase levels. Urinary hydroxyproline excretion increased in group 3 at the end of 2 yr, but remained the same in groups 1 and 2. In conclusion, T4-suppressive therapy was associated with bone loss in postmenopausal women, which could be prevented by either calcium supplementation or intranasal calcitonin, although the latter did not provide additional benefit compared to calcium alone. However, careful titration of T4 dosage to maintain biochemical euthyroidism is a better way to avoid the adverse effect of T4 on bone.en_HK
dc.format.extent418 bytes-
dc.format.mimetypetext/html-
dc.languageengen_HK
dc.publisherThe Endocrine Society. The Journal's web site is located at http://jcem.endojournals.orgen_HK
dc.relation.ispartofJournal of Clinical Endocrinology and Metabolismen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.rightsJournal of Clinical Endocrinology and Metabolism. Copyright © The Endocrine Society.en_HK
dc.titlePrevention of bone loss induced by thyroxine suppressive therapy in postmenopausal women: The effect of calcium and calcitoninen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0021-972X&volume=81&issue=3&spage=1232&epage=1236&date=1996&atitle=Prevention+of+bone+loss+induced+by+thyroxine+suppressive+therapy+in+postmenopausal+women:+the+effect+of+calcium+and+calcitoninen_HK
dc.identifier.emailKung, AWC:awckung@hku.hken_HK
dc.identifier.authorityKung, AWC=rp00368en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1210/jc.81.3.1232en_HK
dc.identifier.pmid8772604-
dc.identifier.scopuseid_2-s2.0-0029866430en_HK
dc.identifier.hkuros10867-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0029866430&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume81en_HK
dc.identifier.issue3en_HK
dc.identifier.spage1232en_HK
dc.identifier.epage1236en_HK
dc.identifier.isiWOS:A1996TZ90600064-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridKung, AWC=7102322339en_HK
dc.identifier.scopusauthoridYeung, SSC=7102767673en_HK

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