Evaluation and Management of Bone Health in Patients with Thyroid Diseases: A Position Statement of the Korean Thyroid Association

Abstract

Thyroid hormones play an important physiological role in maintaining adult bone structure and strength. Consequently, thyroid dysfunction is related to skeletal outcomes. Overt hyperthyroidism is an established cause of high bone turnover with accelerated bone loss, leading to osteoporosis and increased fracture risk. Hyperthyroidism induced by thyroid-stimulating hormone-suppressive therapy in patients with differentiated thyroid cancer is a cause of secondary osteoporosis. In contrast, there is a lack of evidence on the negative impact of hypothyroidism on bone health. Considering the clinical updates on the importance of bone health in thyroid dysfunction, the Task Force from the Clinical Practice Guidelines Development Committee of the Korean Thyroid Association recently developed a position statement on the evaluation and management of bone health of patients with thyroid diseases, particularly focused on endogenous hyperthyroidism and thyroid-stimulating hormone-suppressive therapy-associated hyperthyroidism in patients with differentiated thyroid cancer. Herein, we review the Korean Thyroid Association's position statement on the evaluation and management of bone health associated with thyroid diseases.

Keywords: Bone density; Hyperthyroidism; Osteoporosis; Thyroid hormones; Thyroid neoplasms.

Fig. 1.

Evaluation and management of bone health in (A) women and (B) men with hyperthyroidism. Anti-osteoporosis treatment includes therapy with anti-resorptive agents (e.g., bisphosphonates) and anabolic agents. Certain types of bisphosphonates (e.g., ibandronate) are not approved for men. DXA, dual-energy X-ray absorptiometry; BMD, bone mineral density; Ca/D, calcium and vitamin D; Tx, therapy. ^aCa/D±Osteoporosis Tx: Treatment for osteoporosis can be considered in combination with calcium and vitamin D replacement; ^bCa/D+Osteoporosis Tx: Treatment for osteoporosis is needed in combination with calcium and vitamin D replacement.

Fig. 2.

Evaluation and management of bone health in (A) women and (B) men with differentiated thyroid cancer (DTC) receiving thyroidstimulating hormone (TSH)-suppressive therapy. Anti-osteoporosis treatment includes therapy with anti-resorptive agents (e.g., bisphosphonates) and anabolic agents. Certain types of bisphosphonates (e.g., ibandronate) are not approved for men. DXA, dual-energy X-ray absorptiometry; BMD, bone mineral density; Ca/D, calcium and vitamin D; Tx, therapy. ^aThe high-risk group for osteoporosis and fragility fractures had a previous history of fragility fractures, had amenorrhea for more than 1 year (for women), had other medical diseases, and took medications that cause osteoporosis; ^bCa/D±Osteoporosis Tx: Treatment for osteoporosis can be considered in combination with calcium and vitamin D replacement; ^cCa/D+Osteoporosis Tx: Treatment for osteoporosis is needed in combination with calcium and vitamin D replacement.