The Effects of thyroid medication on bone mineral density: a Study of Women’s Health Across the Nation (SWAN) pharmacoepidemiology studyEdwards, Eric (2019) The Effects of thyroid medication on bone mineral density: a Study of Women’s Health Across the Nation (SWAN) pharmacoepidemiology study. Master Essay, University of Pittsburgh.
AbstractBackground: As women progress through menopause, bone mineral density (BMD) slowly decreases due to estrogen loss. Several studies suggest that medications taken for hypothyroidism do not have a significant effect in the rate of BMD loss while others suggest that thyroid medication could decrease BMD and increase the risk of fractures, osteoarthritis and osteoporosis. Objective: To determine if women who initiate thyroid medication for hypothyroidism experience an increase loss in BMD at the femoral neck (FN), hip or spine compared to non -initiators. Methods: We investigated changes in BMD associated with new use of thyroid hormone therapy in a prospective longitudinal cohort of mid-life women. BMD and medication use were measured annually over a period of 16-years. Propensity score matching (PS) was applied to balance baseline characteristics of women who did and did not initiate thyroid medications. Mixed model regression was used to examine annualized change in BMD. Covariates with a known impact on bone health (age, race, body mass index (BMI), menopausal status, thiazide diuretic and hormone use) were included in all models. Results: Our cohort included 356 women (n=178 in each group) with a mean age of 52.9 (SD=5.6) years and BMI of 29.4 (SD=6.8). 64.3 % of the women were Caucasian, 19.9% African American, 9.6% Chinese and 6.2% Japanese. Median follow-up time was 9.5 years. After adjusting for the variables mentioned above, the annual rate of bone loss at the FN, hip and spine for the treatment and control groups were FN (- 0.71% vs. – 0.85% p= 0.22), hip (-0.57% vs -0.66% p=0.47), and spine (-0.59 vs -0.71% p=0.41). Conclusion: After employing a pharmacoepidemiology design and PS matching there were no significant differences in BMD between those who used thyroid medications and those who did not at either the FN, total hip, or spine. Public Health Significance: The findings in this study will help women who are using thyroid hormone therapy during the menopausal transition know that it does not affect their risk of developing osteoporosis or bone loss. The results of this study can help inform clinicians to better focus their time in known variables that effect BMD loss such as thiazide diuretics, body mass index, smoking status, and diabetes. This information will help doctors better educate patients on preventative measures that can help decrease the rate of bone loss through the menopausal transition. Share
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