Roberts, Jimmie
(2021)
Investigation of Bone-Mineral Density while using Thyroid Medication: a SWAN Cohort Study.
Master Essay, University of Pittsburgh.
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Abstract
Hypothyroidism, a condition of decreased thyroid hormone secretion, can result in severe skeletal deficiencies. These deficiencies can result in impaired bone maturation and have been associated with an increased risk for bone fractures. Although numerous studies have examined the effect of thyroid hormones on the change in bone mineral density (BMD), they are inconsistent in their results. None have constrained for new users to thoroughly investigate the effect of the medication on the bone. This is problematic because including both incident and prevalent users in the analysis may lead bias. Our objective is to estimate the effect of thyroid medication use on BMD in women with hypothyroidism during the menopausal transition.
We investigated the annual percent BMD loss in the lumbar spine, femoral neck, and total hip among women who initiated thyroid medication for hypothyroidism in the Study of Women’s Health Across the Nation (SWAN). We used the “new user” design, which classifies persons as “users” if they are incident users rather than prevalent users. Propensity score (PS) matching was used to obtain a comparable group of women who initiated medication and women who did not initiate medication. Mixed-effects regression modeling was used to compare the longitudinal annualized rate of change in BMD at a given site using covariates that have a potential effect on bone health.
Both thyroid hormone users (N=209) and non users (N=209) lost BMD at each of the measured sites over time. The difference in the mean annualized percent for the change in BMD between the thyroid medication user group and the non-user group was not statistically significant at the lumbar spine (-0.208 vs -0.139; p = 0.561), the femoral neck (-0.582 vs -0.415; p = 0.183), nor the total hip (-0.455 vs -0.372; p = 0.455). These results suggest that thyroid hormone use does not have a significant effect on BMD .
Public Health Significance: Hypothyroidism is expected to increase as the population ages. Determining if and how initiating thyroid treatment for hypothyroidism is associated with relevant health outcomes could prove to be significant for public health practice.
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Investigation of Bone-Mineral Density while using Thyroid Medication: a SWAN Cohort Study. (deposited 10 Feb 2021 16:05)
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