TSH-suppressive therapy can reduce bone mineral density in patients with differentiated thyroid carcinoma: a meta-analysis

Abstract

Objective: To evaluate the effect of TSH-suppressive therapy on the bone mineral density in patients with differentiated thyroid carcinoma (DTC).

Materials and methods: The cross-sectional, cohort, prospective controlled, and case-control studies on the bone mineral density change in patients with DTC after TSH-suppressive therapy from databases were searched, including PubMed, Embase, and Cochrane library databases. The effect of TSH-suppressive therapy on bone mineral density of lumbar, femoral neck, femoral greater trochanter, and Ward triangle was analyzed. Data from the database establishment to January 2019 were all reviewed. Meta-analysis was performed with RevMan 5.3 software after two reviewers independently screened the date. The categorical variables were expressed as odds ratios, while the numerical variables were expressed as mean differences. Based on the heterogeneity of the study, a comprehensive analysis was performed by using fixed or random effect models.

Results: A total of 11 studies involving 434 patients with differentiated thyroid cancer were included. No significant difference in the bone mineral density of lumbar indications between the experimental and control groups was observed (MD=0.00, 95% CI=-0.03-0.03, p=0.96). The bone mineral density of the femoral neck indications (MD=-0.01, 95% CI=-0.04-0.03, p=0.70). A significant difference between experimental and control groups in the bone mineral density of femoral trochanter indications was observed (MD=-0.11, 95% CI=-0.14-0.07, p<0.00001). The bone mineral density of Ward's triangle indications (MD=-0.06, 95% CI=-0.11-0.01, p=0.02).

Conclusions: TSH-suppressive therapy in patients with DTC mainly reduces the proximal femur bone mineral density.