Risk of Osteoporosis and Fractures in Patients with Thyroid Cancer: A Case-Control Study in U.S. Veterans
Open accessAbstract
Background: Data on osteoporosis and fractures in patients with thyroid cancer, especially men, are conflicting. Our objective was to determine osteoporosis and fracture risk in U.S. veterans with thyroid cancer. Materials and Methods: This is a case-control study using the Veterans Health Administration Corporate Data Warehouse (2004–2013). Patients with thyroid cancer (n = 10,370) and controls (n = 10,370) were matched by age, sex, weight, and steroid use. Generalized linear mixed-effects regression model was used to compare the two groups in terms of osteoporosis and fracture risk. Next, subgroup analysis of the patients with thyroid cancer using longitudinal thyroid-stimulating hormone (TSH) was performed to determine its effect on risk of osteoporosis and fractures. Other covariates included patient age, sex, median household income, comorbidities, and steroid and androgen use. Results: Compared with controls, osteoporosis, but not fractures, was more frequent in patients with thyroid cancer (7.3% vs. 5.3%; odds ratio [OR], 1.33; 95% confidence interval [CI], 1.18–1.49) when controlling for median household income, Charlson/Deyo comorbidity score, and androgen use. Subgroup analysis of patients with thyroid cancer demonstrated that lower TSH (OR, 0.93; 95% CI, 0.90–0.97), female sex (OR, 4.24; 95% CI, 3.53–5.10), older age (e.g., ≥85 years: OR, 17.18; 95% CI, 11.12–26.54 compared with <50 years), and androgen use (OR, 1.63; 95% CI, 1.18–2.23) were associated with osteoporosis. Serum TSH was not associated with fractures (OR, 1.01; 95% CI, 0.96–1.07). Conclusion: Osteoporosis, but not fractures, was more common in U.S. veterans with thyroid cancer than controls. Multiple factors may be contributory, with low TSH playing a small role. Implications for Practice: Data on osteoporosis and fragility fractures in patients with thyroid cancer, especially in men, are limited and conflicting. Because of excellent survival rates, the number of thyroid cancer survivors is growing and more individuals may experience long-term effects from the cancer itself and its treatments, such as osteoporosis and fractures. The present study offers unique insight on the risk for osteoporosis and fractures in a largely male thyroid cancer cohort. Physicians who participate in the long-term care of patients with thyroid cancer should take into consideration a variety of factors in addition to TSH level when considering risk for osteoporosis.
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Several large cohorts or prospective studies reporting the prevalence of osteoporosis or fractures in patients with TSH suppression therapy were not included because they did not provide accurate data.
“In addition, several large cohorts or prospective studies reporting the prevalence of osteoporosis or fractures in patients with TSH suppression therapy were not included because they did not provide the accurate data (52)(53)(54)(55).”
From Effect of TSH Suppression Therapy on Bone Mineral Density in Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis (2021) · cites this paper as [52]
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- Authors
- Papaleontiou, M., Banerjee, M., Reyes-Gastelum, D., Hawley, S. T., & Haymart, M. R.
- Affiliations
- University of Michigan (US)
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA
- Corresponding author
- Papaleontiou, Maria
- Venue
- The Oncologist
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-06-04
- Volume
- 24
- Issue
- 9
- Pages
- 1166-1173
- ISSN
- 1083-7159 (ISSN-L)
- 1549-490X
- PMC
- PMC6738319
- OpenAlex
- W2948893745
- Cited by
- 38
- References
- 30
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 3 · 2023: 2 · 2022: 8 · 2021: 7 · 2020: 7 · 2019: 1
- FWCI
- 6.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Oncologist (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- Agency for Healthcare Research and Quality (R01 HS024512)
- National Institute on Aging (K08 AG049684)
- National Institutes of Health (R01 CA201198)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Keywords
- thyroid cancer, osteoporosis, fragility fractures, thyroid-stimulating hormone, veterans, sex differences, age effects, comorbidities, cancer survivors, bone health, glucocorticoid use, thyroid hormone replacement, bone mineral density, fracture risk factors, cancer treatment side effects, long-term cancer survivorship
- MeSH terms
- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Osteoporosis, Retrospective Studies, Risk Factors, Thyroid Neoplasms, United States, Veterans, Comorbidity, Case-Control Studies, Databases, Factual, Fractures, Bone
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