- Rahmatollah Hafezi
- - Department of Physiotherapy, Faculty of Medicine, Baghiat-allah University of Medical Sciences, Tehran, Iran
- Zohreh Hamidi
- - Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences, Tehran, Iran
- Akbar Soltani
 - - Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences, Tehran, Iran
- Abbas Ali Keshtkar
- 1- Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences, Tehran, Iran
- 2- Tehran University of Medical Sciences, Tehran, Iran
Received: 1/1/2005 Accepted: 1/1/2005 - Publisher : Avicenna Research Institute |
|
| Related Articles |
|
| Other Format |
|
|
|
Abstract
Introduction: Many patients using Levothyroxine, have osteopenia or even osteoporosis by the definition of the World Health Organization based on bone mineral density (BMD). Dual-energy X-ray absorptiometry (DXA) of femur and spine, the standard method for diagnosis of osteoporosis, needs nonportable devices that are not available everywhere. DXL (DXA of calcaneus) is a mobile and less expensive method for assessing the bone. There is little data about this method's correlation with DXA in patients using Levothyroxine. The present study assessed the value of DXL in detecting changes in bone structure in these patients compared with DXA. Materials and Methods: In a cross-sectional analysis, 62 patients (4 men) with a mean age of 53.32+-10.54 years, were studied. A GE-Lunar device (DPX-MD) used for DXA of the hip (neck and total) and spine. DXA of the calcaneus measured using a Demeteck device. SPSS (10) was used for statistical analysis. Sensitivity and specificity of DXL method were measured with ROC curve. P- Value less than 0.05 were considered significant. Results: The mean age of patients was 53.3210.54 years. Osteoporosis found in 18% of patients in any of the total of femur or L2-L4 regions (6% in total region, 16% in L2-L4 regions). Using DXL, osteoporosis diagnosed in 18% of patients. Using ROC curve, sensitivities of T-score ≤-2.5 of calcaneus for diagnosing of osteoporosis in total of hip and L2-L4 regions were respectively 75% and 60% and specificities were respectively 88.2% and 90.2% .Area under curve of total and spine regions were 0.975 (P-value=0.002) ,0.866 (P-value=0.000), respectively. Conclusion: DXL (DXA of calcaneus) can be recommended for screening of osteoporosis among Levothyroxine user patients. Those suspected of osteoporosis, should be examined by additional DXA measurement for establishment of diagnosis before initiation of therapy.
Keywords:
Osteoporosis, BMD, DXA, DXL, Levothyroxine To cite this article:References
- Eastell R. Treatment of postmenopausal osteo-porosis. N Engl J Med.1998;338:736-46.
- WHO study group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Technical report series43.Geneva: WHO.1994.
- Kanis J.A., Devogelaer J.P., Gennari C. Practical guide for the use of bone mineral measurements in the asessment of treatment of osteoporosis: a posi-tion paper of the European Foundation for Osteopo-rosis and Bone Disease. Osteoporos Int.1996;6: 256-61.
- Bauer D.C., Nevitt M.C., Ettinger B., Stone K. Low thyrotropin levels are not associated with bone loss in older women: a prospective study. J Clin Endocrinol Metab.1997;82:2931-2936.
- Uzzan B., Campos J., Cucherat M., Nony P., Boissel J.P., Perret G.Y. Effects on bone mass of long-term treatment with thyroid hormones: a meta-analysis.J Clin Endocrinol Metab.1996;81:4278-89.
- Mosekilde L., Eriksen E.F., Charles P. Effects of thyroid hormones on bone and mineral metabolism. Endocrinol Metab Clin North Am.1990;19:35-63.
- Mosekilde L., Melsen F., Bagger J.P., Myhere- Jensen O., Sorensen N.S. Bone changes in hyper-thyroidism. Interrelationship between bone morpho-metry, thyroid function and calcium-phosphorus metabolism. Acta Endocrinol.1977;85:515-525.
- Wartofsky L. Osteoporosis:a growing concern for the thyroidologist. Thyroid Today.1988;11:1-11.
- Auwerx J., Bouillon R. Mineral and bone meta-bolism in thyroid disease: a review. Q J Med.1986; 60:737-752.
- Baran D.T., Braverman L.E. (Editorial). Thyro-id hormones and bone mass. J Clin Endocrinol Metab.1991;72:1182-1183.
- Wu¨ster C., Schilddru¨ S. Osteoporose In Schil-ddru¨se 1993: Therapie der Hyperthyreose,pp380-392. Eds D Reinwein & B Weinheimer. Berlin, New York: DeGryter,1994.
- Ross D.S., Neer R.M., Ridgway E.C., Daniels G.H. Subclinical hyperthyroidism and reduced bone density as a possible result of prolonged supper-ssion of the pituitary-thyroid axis with L-thyroxine. Am J Med.1987; 82:1167-70.
- Paul T.L., Kerrigan J., Kelly A.M., Braverman L.E.,Baran D.T. Longterm L-thyroxine therapy is associated with decreased hip bone density in pre-menopausal women. JAMA.1988;259:3137-3141.
- Taelman P., Kaufman J.M., Janssens X., Vand-ecauter H., Vermeulen A. Reduced forearm bone mineral content and biochemical evidence of incr-eased bone turnover in women with euthyroid goiter treated with thyroid hormone. Clin Endo-crinol.1990;33:107-17.
- Diamond T., Nery L., Hales I. A therapeutic dilemma: suppressive doses of thyroxine signify-cantly reduce bone mineral measurements in both premenopausal and postmenopausal women with thyroid carcinoma. J Clin Endocrinol Metab.1990; 72:1184-88.
- Guo C.Y., Weetman P., Eastell R. Longitudinal changes of bone mineral density and bone turnover in postmenopausal women on thyroxine. Clin End-ocrinol.1997;46:301-7.
- Hawkins F., Rigopoulou D., Papapietro K., Lopez M.B. Spinal bone mass after long-term treat-ment with l-thyroxine in postmenopausal women with thyroid cancer and chronic lymphocytic thyro-iditis. Calcif Tissue Int.1994;54:16-9.
- Nuzzo V., Lupoli G., Del Puente A., Rampone E., Carpinelli A. Esposito Del Puente A. Bone min-eral density in premenopausal women receiving levothyroxine suppressive therapy. Gynecol Endo-crinol.1998;12: 333-337.
- Mu¨ller C.G., Bayley T.A., Harrison J.E., Tsang R. Possible limited bone loss with suppressive thy-roxine therapy is unlikely to have clinical releva-nce. Thyroid.1995;5:81-87.
- Leese G.P., Jung R.T., Guthrie C., Waugh N., Browning M.C. Morbidity in patients on L-thyro-xine: a comparison of those with a normal to those with a suppressed TSH. Clin Endocrinol.1992;37: 500-3.
- Salomon B.L., Wartofsky L., Burman K.D. Pre-valence of fractures in postmenopausal women with thyroid disease. Thyroid.1993;3:17-23.
- Kung A.W.C., Pun K.K. Bone mineral density in premenopausal women receiving long-term phys-iological doses of thyroxine. JAMA.1991;265: 2688-91.
- Grant D.J., McMurdo M.E.T., Mole P.A., Paterson C.R., Davies R.R. Suppressed TSH levels secondary to thyroxine replacement therapy is not associated with osteoporosis. Clin Endocrinol. 1993;39:529-533.
- Schneider D.L., Barrett-Connor E.L., Morton D.J. Thyroid hormone use and bone mineral density in elderly women. Effects of estrogen. JAMA.1994; 271:1245-9.
- Franklyn J.A., Betteridge J., Dykin J., Holder R., Oates G., Parle J.V. Long-term thyroxine treat-ment and bone mineral density. Lancet.1992;340:9-13.
- Cummings S.R., Black D.M., Nevitt M.C., Browner W.S., Cauley J.A., Genant H.K., Mascioli S.R., Scott J.C., Seeley D.G., Steiger P. Append-icular bone density and age predict hip fracture in women. The Study of Osteoporotic Fractures Res-earch Group. JAMA.1990;263:665-8.
- Wasnich R.D., Ross P.D., Heilbrun L.K., Vogel J.M. Selection of the optimal skeletal site for frac-ture risk prediction.Clin Orthop.1987;216:262-9.
- Vogel J.M., Wasnich R.D. Ross P.D. The clinical relevance of calcaneus bone mineral measu-rements: a review. Bone Miner.1988;5:35-58.
- Riario-Sforza G.G., Incorvaia C., Scazzoso A., Travisi T., Nitti F., Fumagalli M. Cut off values of bone mineral density defining postmenopausal wo-men with bone fractures. Ann Rheum Dis. 1995; 54:807-10.
- Hui S.L., Slemenda C.W., Johnston C.C. Jr. Baseline measurement of bone mass predicts frac-ture in white women. Ann Intern Med.1989;111: 355-61.
- Gardsell P., Johnell O., Nilsson B.E., Nilsson JA. The predictive value of fracture, disease, and falling tendency for fragility fractures in women. Calcif Tissue Int.1989;45:327-30.
- Black D.M., Cummings S.R., Genant H.K, Ne-vitt M.C., Palermo L., Browner W. Axial and appe-ndicular bone density predict fractures in older women. J Bone Miner Res.1992;7:633-8.
- Baran D.T., Faulkner K.G., Genant H.K., Miller P.D., Pacifici R. Diagnosis and management of ost-eoporosis: guidelines for the utilization of bone densitometry. Calcif Tissue Int.1997;61:433-40.
- Pacheco E.M.B., Harrison E.J., Ward K.A., Lunt M., Adams J.E. Detection of osteoporosis by Dual Energy X-ray Absorptiometry (DXA) of the Calcaneus: Is the WHO Criterion applicable? Cal Tis Int.2002;70:475-482.
- Kullenberg R., Falch J.A. Prevalence of osteoporosis using bone mineral easurements at the calcaneus by dual X-ray and laser (DXL). Osteoporos Int.14:823-7.
- Wasnich R.D., Ross P.D. A comparison of single and multi-site BMC Measurements for asse-ssment of spine fracture probability. J Nucl Med. \1989;30:1166-177.
- Melton L.J., Atkinson E.J., O'Fallon W.M., Wa-hner H.W., Riggs B.L. Long-term fracture predict-tion by bone mineral assessed at different skeletal sites. J Bone Miner Res.1993;8:1227-33.