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ORIGINAL ARTICLE
Year : 2012  |  Volume : 1  |  Issue : 2  |  Page : 60-70

Effect of block-replacement regimen on bone mineral density and biochemical markers in patients with thyrotoxic bone disease


1 Department of Endocrinology and Metabolism, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
2 Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, India

Correspondence Address:
Alok Sachan
Associate professor, Department of Endocrinology and Metabolism, SriVenkateswara Institute of Medical Sciences, Tirupati 517507
India
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Source of Support: None, Conflict of Interest: None


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Intsroduction: Abnormal bone metabolism in patients with thyrotoxicosis is well documented, but time-course of recovery remains poorly understood. Objective: To evaluate changes in bone density and bone metabolic parameters in thyrotoxicosis before and after therapy. Methods: Forty patients with thyrotoxicosis (11 males; mean age 35.5 ± 9.9 years) rendered euthyroid with methimazole and maintained on block-replacement therapy were followed up for six months at a tertiary care setting. Of these, 21 had completed follow-up evaluation. Bone mineral density (BMD) at lumbar spine (LS), hip and biochemical markers were estimated before and after therapy. Results: At LS, 21% women and 35% men had a Z score less than -2. At the neck of femur (NOF),17% women and 18% men had Z score less than -2. LS was more severely affected (p < 0.001). BMD was similar among patients who were 25- hydroxy vitamin D [25(OH)D] deficient,[25(OH)D < 20 ng/mL (<50 nmol/L)], insufficient [25(OH)D 20 - 30 ng/mL (50-75 nmol/L)] or sufficient [25(OH)D > 30 ng/mL (>50 nmol/L)]. Serum T4 correlated negatively with Z-scores at LS, NOF, trochanter and Ward’s area. There was improvement in BMD (p<0.01) and Z scores (p<0.01) at all levels post-treatment with higher increase at NOF (p=0.046). A significant decrease in serum calcium, 24 hour urinary calcium and phosphate and the fractional excretions of calcium and phosphate was also seen, while serum N-tact PTH levels increased. Conclusions: Correction of hyperthyroidism plays a pivotal role in improving the BMD and biochemical parameters.


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