Keywords
Hospitalized patients
Bone density
Submitted : 2025-06-04
Accepted : 2025-06-19
Published : 2025-07-04
Abstract
Objective: To analyze the clinical characteristics of bone loss in hospitalized patients with Graves’ disease. Methods: The clinical data of hospitalized patients with Graves’ disease were collected. According to the results of bone density examinations, they were divided into a normal bone density group, a low bone mass group, and an osteoporosis group. The normal bone density group was used as the control group to analyze the clinical characteristics of bone loss. Results: The incidence of bone loss in patients with Graves’ disease was 80.72%, with osteoporosis accounting for 39.16% and low bone mass accounting for 41.57%. The incidences of hyperthyroid heart disease, Graves’ ophthalmopathy, and leukopenia in the osteoporosis group and the low bone mass group were significantly higher than those in the normal bone density group, reaching 84.62%, 60.87%, and 34.38%, respectively (P < 0.05). The age of the osteoporosis group with Graves’ disease was 50.88 ± 12.03 years old, which was higher than that of the normal bone density group (40.03 ± 12.58 years old). The disease course was 55.66 ± 14.21 days, longer than that of the normal bone density group (43.38 ± 8.55 days). FT4 was 61.69 ± 8.42 pmol/L, higher than that of the normal bone density group (51.01 ± 6.77 pmol/L), while TSH was 0.08 ± 0.51 μIU/ml, lower than that of the normal bone density group (0.22 ± 0.55 μIU/ml). The blood phosphorus was 1.25 ± 0.29 mmol/L, lower than that of the normal bone density group (1.34 ± 0.27 mmol/L), with statistical significance (P < 0.05). In the low bone mass group, FT3 (13.08 ± 9.05 pmol/L) and FT4 (46.14 ± 3.46 pmol/L) were lower than those in the normal bone density group, with statistical significance (P < 0.05). Logistic regression analysis revealed that age, disease course, and TSH were contributing factors to bone loss. Conclusion: Patients with Graves’ disease are prone to bone loss, and age, disease course, and TSH are contributing factors to bone loss.
References
Gorka J, Taylor-Gjevre RM, Arnason T, 2013, Metabolic and Clinical Consequences of Hyperthyroidism on Bone Density. International Journal of Endocrinology, 22: 638–727. DOI: 10.1155/2013/638727
Huang L, Li X, Mu L, et al., 2011, Prevalence of Osteoporosis and Characteristics of Bone Turnover Markers in Patients with Graves’ Disease. Chinese Journal of Endocrinology and Metabolism, 27: 906–910. DOI: 10.3760/cma.j.issn.1000-6699.2011.11.009
Hudec S, Camacho P, 2012, Secondary Causes of Osteoporosis. Endocrine Practice, 19(1): 1–31.
Ercolano MA, Drnovsek ML, Silva Croome MC, et al., 2013, Negative Correlation Between Bone Mineral Density and TSH Receptor Antibodies in Long-Term Euthyroid Postmenopausal Women With Treated Graves’ Disease. Thyroid Research, 6(1): 11.
Chen L, Zhao S, Dai X, 2021, Correlation Analysis of Bone Density and Serum Bone Metabolism Indexes in Patients With Hyperthyroidism. Chinese Journal of Primary Medicine and Pharmacy, 28(4): 495–499.DOI: 10.3760/cma.j.issn.1008-6706.2021.04.004
Cao X, Zhang Z, Wang N, 2024, Correlation Study on the Level of Thyrotropin and Bone Density in Elderly Patients. China Science and Technology Journal Database Medicine, 2024(2): 67–70.
Fu Y, Wu D, Zhao E, et al., 2024, Evidence-Based Basis and Possible Mechanisms of Systemic Bone Loss After Osteoporotic Fractures. Chinese Journal of Osteoporosis, 30(5): 749–754, 774.
Wang S, Wang Y, Zhu L, et al., 2023, Effects of TSH Suppressive Therapy on Bone Mineral Density (BMD) and Bone Turnover Markers (BTMs) in Patients With Differentiated Thyroid Cancer in Northeast China: A Prospective Controlled Cohort Study. Endocrine, 79(1): 113–124.
Qiao H, Ding H, Sun J, 2023, Correlation Among Bone Density, Bone Metabolism and Adipocytokines in Patients With Hyperthyroidism. Henan Medical Research, 32(22): 4091–4095.
Liao Q, He S, Xiao Z, et al., 2021, Correlation Analysis of the Positive Rate of TRAb in Serum Thyroid Function and the Levels of TSH, FT₃, FT₄, T₃, T₄ in Pregnant Women With Hyperthyroidism During Pregnancy. Chinese and Foreign Medical Research, 19(11): 81–84.
Simsek Y, Tofil H, Rosenthal M, et al., 2024, Nuclear Receptor Corepressor 1 Levels Differentially Impact the Intracellular Dynamics of Mutant Thyroid Hormone Receptors Associated With Resistance to Thyroid Hormone Syndrome. Molecular and Cellular Endocrinology, 594: 112373.
Khamisi S, Lundqvist M, Rasmusson A, et al., 2023, Vitamin D and Bone Metabolism in Graves’ Disease: A Prospective Study. Journal of Endocrinological Investigation, 46: 425–433.
Yang X, Yang L, 2023, Relationship Between Subclinical Thyroid Dysfunction and Osteoporosis and Research Progress. Advances in Clinical Medicine, 13(6): 10124–10129.
Qi W, Wang D, Hong Y, et al., 2024, Investigating the Causal Relationship Between Thyroid Dysfunction Diseases and Osteoporosis: A Two-Sample Mendelian Randomization Analysis. Scientific Reports, 14: 12784.
Branstetter R, Islam R, Toups C, et al., 2023, Mechanisms and Treatment Options for Hyperthyroid-Induced Osteoporosis: A Narrative Review. Cureus, 15(11): e48798.
Wen B, Xiang Q, 2022, Research Progress on the Pathogenesis and Clinical Characteristics of Hyperthyroid Osteoporosis. China Modern Medicine, 29(32): 28–32.
Zhou Q, Li J, 2024, Study on the Relationship Between Thyroid Hormone Sensitivity and Osteoporosis in Euthyroid Population. Chinese Journal of Endocrinology and Metabolism, 40(4): 320–325.
Delitala A, Scuteri A, Doria C, 2020, Thyroid Hormone Diseases and Osteoporosis. Journal of Clinical Medicine, 9(4): 1034.
Hong AR, Kang HC, 2023, Evaluation and Management of Bone Health in Patients With Thyroid Diseases: A Position Statement of the Korean Thyroid Association. Endocrinology and Metabolism (Seoul), 38(2): 175–189.
Ma T, Chen D, Wang W, 2022, Relationship Between Osteoporosis and Hyperthyroidism. Chinese Journal of Osteoporosis, 28(3): 380–385, 439.
Fan Y, Shao M, Wang J, et al., 2022, Correlation Analysis of Thyrotropin Receptor Antibodies and Bone Turnover Markers in Newly Diagnosed Patients With Graves’ Disease. Chinese Journal of Endocrinology and Metabolism, 38(5): 7.
Tsevis K, Trakakis E, Pergialiotis V, et al., 2018, The Impact of Thyroid Diseases on Bone Density and Biochemical Markers of Bone Metabolism. Hormone Molecular Biology and Clinical Investigation, 35(1): 20180039.
Deng T, Zhang W, Zhang Y, et al., 2021, Thyroid-Stimulating Hormone Decreases the Risk of Osteoporosis by Regulating Osteoblast Proliferation and Differentiation. BMC Endocrine Disorders, 21: 49.
Yao N, Li P, Geng C, et al., 2021, Research Progress on the Pathogenesis of Postmenopausal Osteoporosis Mediated by TNF-α. Chinese Journal of Osteoporosis, 27(3): 454–458.
Chung CW, Choi HS, Kong SH, et al., 2021, Postmenopausal Women’s Bone Health Measurement After Thyrotropin Suppression Therapy for Differentiated Thyroid Cancer: Bone Mineral Density and Trabecular Bone Score. Journal of Clinical Medicine, 10(9): 1964.
Owen X, Qi Z, 2006, Relationship Between the Levels of Calcium, Phosphorus, and Magnesium in the Serum of 53 Hyperthyroid Patients and Osteoporosis. Guangdong Medical Journal, 27(7): 1068–1069.
Zhu J, Chen K, Wang H, et al., 2005, Abnormal Thyroid Function and Bone Loss in Elderly Women. Chinese Journal of Osteoporosis, 11(4): 464–466.
Reddy PA, Harinarayan CV, Sachan A, et al., 2012, Bone Disease in Thyrotoxicosis. Indian Journal of Medical Research, 135: 277–286.
Tuchendler D, Bolanowski M, 2013, Assessment of Bone Metabolism in Premenopausal Females With Hyperthyroidism and Hypothyroidism. Endokrynologia Polska, 64(1): 40–44.