The impact of thyroid autoimmunity (TPOAb) on bone density and fracture risk in postmenopausal women

Abstract

ObJeCTIVe: Skeletal development, linear growth, cartilage biology and bone turnover are highly dependent on the activity of thyroid hormones. Thyroid dysfunction affects the skeleton, and autoimmune thyroid disease, manifesting as a chronic inflammatory condition, may be an important contributing factor to impaired bone quality in these patients. MATeRIAlS AND MeTHODS: Measurement of TSH, FT4, TPOAb and bone mineral density and FRAX score calculations were performed in 189 postmenopausal women (110 euthyroid women and 79 women diagnosed with subclinical hypothyroidism) divided into subgroups according to the presence of TPOAb. ReSUlTS: In multivariate logistic regression analysis only TPOAb were found to be significantly related to fracture, independently of TSH values (p=0.018; OR=7.800; 95% CI 1.424-42.721). Lower bone mineral density and FRAX score for hip and for major osteoporotic fractures were associated with the presence of TPOAb in euthyroid postmenopausal women in an unadjusted logistic regression model, as well as in a model adjusted for age, bMI and smoking. TSH was a better predictive factor for fractures in women with subclinical hypothyroidism (FRAX main p <0.001; 95% CI for SE 0.858-0.959 and FRAX hip p <0.001; 95% CI for SE 0.628-0.854). CONCLUSION: Autoimmune thyroid disease is associated with decreased bone mineral density at both spine and hip and risk of future fracture incidence in euthyroid postmenopausal women. Presence of TPOAb is a potential marker of higher fracture risk in these patients. However, in subclinical hypothyroidism, TSH is a better indicator of future fragility fractures than TPOAb.

Autoimmunological serum parameters and bone mass density in premature ovarian insufficiency: a retrospective cohort study

“…It obviously supports the assumption that autoimmunity might represent an important driver in pathogenic bone loss [15]. Decreased BMD has been found in patients with SLE [12], chronic thyroiditis [13] and autoimmune hepatitis [14] in previous studies. Although declines in BMD in patients with SLE might also be due to the SLE-related glucocorticoid treatment, several studies have pointed out that autoantibodies were able to induce osteoclast differentiation and activation and to alter bone mineral content.…”

“…Notably, decreased BMD was found in patients with various autoimmune diseases, which include systemic lupus erythematosus [12], serologically suspected chronic thyroiditis [13], and autoimmune hepatitis [14]. These observations are in line with the conclusion of a recent review that autoimmunity seemed to represent an important driver in pathological bone loss [15].…”

Thyroid and bone turnover markers in type 2 diabetes: results from the METAL study

“…Different patterns of associations between BTMs and thyroid measures by the status of thyroid autoantibodies suggest that thyroid autoantibodies should be considered in the regulation of bone metabolism by thyroid hormones. Although one study reported that the presence of TPOAb is a potential marker of higher fracture risk in these patients ( 52 ), associations between BTMs and TPOAb or TgAb status have rarely been assessed in the human population. In the current observational study, while no direct associations were observed between BTMs and thyroid autoantibody status, the associations with TSH, FT 4 , SPINA-G D , SPINA-G T , TTSI and TSHI appeared to be influenced by ATA status.…”

Analyses of the Association between Thyroid Cancer and Osteoporosis/Fracture Histories: A Cross-Sectional Study Using KoGES HEXA Data

“…PTC patients with severe osteoporosis have a higher prevalence of TPO-Ab than patients without severe osteoporosis [ 10 ]. The presence of TPO-Ab is associated with osteoporotic fractures in euthyroid postmenopausal women [ 26 ]. On the other hand, the risk of thyroid cancer is not related to TPO-Ab levels but is associated with Tg-Ab levels [ 27 ].…”