Risk of Osteoporosis and Fractures in Thyroid Cancer Patients: A case-control study in United States Veterans

  • Context: Data on osteoporosis and fractures in thyroid cancer patients, especially men, are conflicting.

    Objective: Determine osteoporosis and fracture risk in United States veterans with thyroid cancer.

    Design, Setting and Participants: This is a case-control study using the Veterans Health Administration Corporate Data Warehouse (2004-2013). Thyroid cancer patients (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 thyroid cancer patients using longitudinal TSH was performed to determine its effect on risk of osteoporosis and fractures. Other covariates included patient age, sex, median household income, comorbidities, steroid and androgen use.

    Main Outcome Measures: Osteoporosis and fractures.

    Results: Compared to controls, osteoporosis, but not fractures, was more frequent in thyroid cancer patients [7.3% versus 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 thyroid cancer patients 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 to <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).

    Conclusions: 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.


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