The effect of vitamin D supplementation on bone mineral density in patients with differentiated thyroid cancer

Year 2024, Volume: 41 Issue: 1, 1 - 8, 29.03.2024

Ebru Yılmaz , Güzin Töre

Abstract

It has demonstrated that there is a connection between chronic TSH suppressive treatment and the reduction of bone mineral density (BMD) or the development of osteoporosis in patients with differentiated thyroid cancer (DTC). The aim of the study was to determine the effect of vitamin D3 supplementation on BMD and the development of osteoporosis in patients with DTC. Two hundred four (204) patients with a diagnosis of DTC were included. All patients received thyroid hormone replacement therapy along with vitamin D (5000IU/day). Data including age, gender, body mass index, smoking, menopausal status, family history of osteoporosis, and postoperative duration were collected. The serum levels of TSH, calcium, 25-OH-vitamin D, and parathyroid hormone measurements and BMD by using dual-energy X-ray absorptiometry were performed on whole patients. The mean age of patients was 56.20±9.31 years. With osteoporosis, 22 of the patients were female (10.8%) and 1 was male (0.5%). Twenty one (21) females with OP were postmenopausal state. There was a statistically significant difference between osteoporosis and age, menopausal status, and family history of osteoporosis, but not for the other factors. Although there was no statistically significant difference between osteoporosis and the levels of TSH and vitamin D, most patients with osteoporosis had TSH<0.5 mIU/mL (n=18) and vitamin D<30 ng/mL (n=16). Age and family history of osteoporosis were identified as independent predictive factors for developing osteoporosis. Vitamin D may be considered as a supplemental and supportive treatment in patients with thyroid cancer for preventing cancer recurrence and osteoporosis.

Keywords

Differentiated thyroid cancer, TSH suppressive therapy, osteoporosis, vitamin D

Supporting Institution

None

Thanks

None

References

• Brito JP, Davies L. Is there really an increased incidence of thyroid cancer? Curr Opin Endocrinol Diabetes Obes. 2014; 21: 405–408. doi: 10.1097/MED.0000000000000094
• Reverter JL, Holgado S, Alonso N, Salinas I, Granada ML, Sanmartí A. Lack of deleterious effect on bone mineral density of long-term thyroxine suppressive therapy for differentiated thyroid carcinoma. Endocr Relat Cancer. 2005; 12: 973–981. doi: 10.1677/erc.1.01072
• Baliram R, Sun L, Cao J, Li J, Latif R, Huber AK, et al. Hyperthyroid-associated osteoporosis is exacerbated by the loss of TSH signaling. J Clin Invest. 2012; 122(10): 3737-3741. doi: 10.1172/JCI63948
• Bennett RG, Wakeley SE, Hamel FG, High RR, Korch C, Goldner WS. Gene Expression of Vitamin D Metabolic Enzymes at Baseline and in Response to Vitamin D Treatment in Thyroid Cancer Cell Lines. Oncology. 2012; 83(5): 264-272. doi: 10.1159/000342093
• Kim D. The Role of Vitamin D in Thyroid Diseases. Int J Mol Sci. 2017; 18(9): 1949. doi: 10.3390/ijms18091949
• Hu N, Zhang H. CYP24A1 depletion facilitates the antitumor effect of vitamin D3 on thyroid cancer cells. Exp Ther Med. 2018; 16(4): 2821-2830. doi: 10.3892/etm.2018.6536
• Wang LY, Smith AW, Palmer FL,Tuttle RM, Mahrous A, Nixon IJ, et al. Thyrotropin Suppression Increases the Risk of Osteoporosis Without Decreasing Recurrence in ATA Low- and Intermediate-Risk Patients with Differentiated Thyroid Carcinoma. Thyroid. 2015; 25(3): 300-307. doi: 10.1089/thy.2014.0287
• Papaleontiou M, Hawley ST, Haymart MR. Effect of Thyrotropin Suppression Therapy on Bone in Thyroid Cancer Patients. Oncologist. 2016; 21(2): 165-171. doi: 10.1634/theoncologist.2015-0179
• Papaleontiou M, Banerjee M, Reyes-Gastelum D, Hawley ST, Haymart MR. Risk of Osteoporosis and Fractures in Patients with Thyroid Cancer: A Case-Control Study in U.S. Veterans. Oncologist. 2019; 24(9): 1166-1173. doi: 10.1634/theoncologist.2019-0234
• Lee Y, Yoon BH, Lee S, Chung YK, Lee YK. Risk of Osteoporotic Fractures after Thyroid-stimulating Hormone Suppression Therapy in Patients with Thyroid Cancer. J Bone Metab. 2019; 26(1): 45-50. doi: 10.11005/jbm.2019.26.1.45
• Yoon BH, Lee Y, Oh HJ, Kim SH, Lee YK. Influence of Thyroid-stimulating Hormone Supression Therapy on Bone Mineral Density in Patients with Differentiated Thyroid Cancer: A Meta-analysis. J Bone Metab. 2019; 26(1): 51-60. doi: 10.11005/jbm.2019.26.1.51
• Soydal Ç, Özkan E, Nak D, Elhan AH, Küçük NÖ, Kır MK. Risk Factors for Predicting Osteoporosis in Patients Who Receive Thyrotropin Suppressive Levothyroxine Treatment for Differentiated Thyroid Carcinoma. Mol Imaging Radionucl Ther. 2019; 28(2): 69-75. doi: 10.4274/mirt.galenos.2019.89410
• Pilz S, Zittermann A, Trummer C, Theiler-Schwetz V, Lerchbaum E, Keppel MH, Grübler MR, März W, Pandis M. Vitamin D testing and treatment: a narrative review of current evidence. Endocr Connect. 2019; 8: R27-R43. doi: 10.1530/EC-18-0432
• McCullough PJ, Lehrer DS, Amend J. Daily oral dosing of vitamin D3 using 5000 TO 50,000 international units a day in long-term hospitalized patients: Insights from a seven year experience. J Steroid Biochem Mol Biol. 2019; 189: 228-239. doi: 10.1016/j.jsbmb.2018.12.010
• Deniz CH, Keskin LH, Secen IE, Yegin FG, Akcay Y, Ustuner I, et al. Thyroid Dysfunction Does Not Affect the Bone Mineral Density in Postmenopausal Women. J Clin Anal Med. 2014; 5(1): 25-28. doi: 10.4328/JCAM.1197
• Tournis S, Antoniou JD, Liakou CG, Christodoulou J, Papakitsou E, Galanos A, et al. Volumetric bone mineral density and bone geometry assessed by peripheral quantitative computed tomography in women with differentiated thyroid cancer under TSH suppression. Clin Endocrinol (Oxf). 2015; 82(2): 197-204. doi: 10.1111/cen.12560
• Moon JH, Jung KY, Kim KM, Choi SH, Lim S, Park YJ, et al. The effect of thyroid stimulating hormone suppressive therapy on bone geometry in the hip area of patients with differentiated thyroid carcinoma. Bone. 2016; 83: 104-110. doi: 10.1016/j.bone.2015.10.015
• Kim CW, Hong S, Oh SH, Lee JJ, Han JY, Hong S, et al. Change of Bone Mineral Density and Biochemical Markers of Bone Turnover in Patients on Suppressive Levothyroxine Therapy for Differentiated Thyroid Carcinoma. J Bone Metab. 2015; 22(3): 135-141. doi: 10.11005/jbm.2015.22.3.135
• Lin SY, Lin CL, Chen HT, Kao CH. Risk of osteoporosis in thyroid cancer patients using levothyroxine: a population-based study. Curr Med Res Opin. 2018; 34(5): 805–812. doi: 10.1080/03007995.2017.1378174
• Wang MY, Han ZQ, Gong XW, Li Q, Ma J. TSH-suppressive therapy can reduce bone mineral density in patients with differentiated thyroid carcinoma: a meta-analysis. European Review for Medical and Pharmacological Sciences. 2020; 24(2): 922–929. doi: 10.26355/eurrev_202001_20077
• Kim DJ, Khang YH, Koh JM, Shong YK, Kim GS. Low normal TSH levels are associated with low bone mineral density in healthy postmenopausal women. Clin Endocrinol (Oxf) 2006; 64(1): 86–90. doi: 10.1111/j.1365-2265.2005.02422.x
• Pater A, Nowacki W, Sypniewska G. Thyroid-Stimulating Hormone Within Normal Range Does Not Affect Bone Turnover in Euthyroid Postmenopausal Women with Osteoporotic Fracture–A Preliminary Report. EJIFCC. 2011; 22(4): 113-117.
• Marwaha RK, Garg MK, Tandon N, Kanwar R, Narang A, Sastry A, et al. Thyroid function and bone mineral density among Indian subjects. Indian J Endocrinol Metab. 2012; 16(4): 575-579. doi: 10.4103/2230-8210.98014
• Arnautovic-Halimic A, Begic A, Agic-Bilalagic S, Basic A, Hadzimuratovic A, Ahmed-Jesenkovic D. Evaluation of Thyroid Hormone Status and Bone Density Ratio in Euthyroid Postmenopausal Women in Early and Late Stage of Bone Loss. Mater Sociomed. 2019; 31(2): 115-118. doi: 10.5455/msm.2019.31.115-118
• Brancatella A, Marcocci C. TSH suppressive therapy and bone. Endocr Connect. 2020; 9(7): R158-R172. doi: 10.1530/EC-20-0167
• Delitala AP, Scuteri A, Doria C. Thyroid Hormone Diseases and Osteoporosis. J Clin Med. 2020; 9(4): 1034. doi: 10.3390/jcm9041034
• Roh JL, Park JY Park CII. Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection. Cancer. 2009; 115(2): 251-258. doi: 10.1002/cncr.24027
• Alhefdhi A, Mazeh H, Chen H. Role of Postoperative Vitamin D and/or Calcium Routine Supplementation in Preventing Hypocalcemia After Thyroidectomy: A Systematic Review and Meta-Analysis. Oncologist. 2013; 18(5): 533-542. doi: 10.1634/theoncologist.2012-0283
• Xing T, Hu Y, Wang B, Zhu J. Role of oral calcium supplementation alone or with vitamin D in preventing post-thyroidectomy hypocalcaemia. Medicine (Baltimore). 2019; 98(8): e14455. doi: 10.1097/MD.0000000000014455
• Zhao J, Wang H, Zhang Z, Zhou X, Yao J, Zhang R, Liao L, Dong J. Vitamin D deficiency as a risk factor for thyroid cancer: A meta-analysis of case-control studies. Nutrition. 2019; 57: 5-11. doi: 10.1016/j.nut.2018.04.015
• Hu MJ, Zhang Q, Liang L, Wang SY, Zheng XC, Zhou MM, Yang YW, Zhong Q, Huang F. Association between vitamin D deficiency and risk of thyroid cancer: a case-control study and a meta-analysis. J Endocrinol Invest. 2018; 41(10):1199-1210. doi: 10.1007/s40618-018-0853-9
• Ikeda K. Vitamin D, Osteoclastogenesis and Bone Resorption: from Mechanistic Insight to the Development of New Analogs. Endocrine Journal. 2007; 54(1): 1-6. doi: 10.1507/endocrj.kr-82
• Kung AW, Yeung SS. Prevention of bone loss induced by thyroxine suppressive therapy in postmenopausal women: the effect of calcium and calcitonin. J Clin Endocrinol Metab. 1996; 81(3): 1232–1236. doi: 10.1210/jcem.81.3.8772604
• Liu H, Ma Q, Han X, Huang W. Bone mineral density and its correlation with serum 25-hydroxyvitamin D levels in patients with hyperthyroidism. J Int Med Res. 2020; 48(2): 300060520903666. doi: 10.1177/0300060520903666