Diana Grove-Laugesen, Eva Ebbehoj, Torquil Watt, Klavs Würgler Hansen, Lars Rejnmark
Journal: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 2024;35(12):2153-2164
PMID: 39264438
Graves' disease, an autoimmune disorder leading to hyperthyroidism, can significantly impact bone health, resulting in decreased bone density and altered bone microarchitecture. The aim of this study was to evaluate changes in bone density and microarchitecture following treatment for Graves' disease and to assess the additional effects of vitamin D supplementation. This research is a randomised clinical trial involving patients diagnosed with Graves' disease, who were divided into groups receiving standard treatment with or without vitamin D supplementation. Results showed that 9 months supplementation with a daily dose of 70 µg vitamin D3 did not improve areal or volumetric bone mineral density (BMD), bone microarchitecture or estimated bone strength in a population with an adequate dietary calcium intake. The only significant effect of vitamin D was a smaller increase in PTH level compared to placebo, whereas there was no impact on bone turnover markers. Authors concluded that 9 months of high dose vitamin D3 supplementation does not offer benefit by improving skeletal health.
UNLABELLED
Thyrotoxicosis leads to loss of bone mass. Vitamin D is important to bone health. In this randomized, placebo-controlled trial, we showed that bone restoration did not improve when adding vitamin D supplementation to standard care of Graves' disease thyrotoxicosis. Bone density and microarchitecture improved markedly with treatment of thyrotoxicosis.
PURPOSE
Vitamin D is important to skeletal health and ensuring a replete vitamin D status is recommended. In thyrotoxicosis, bone turnover is increased and bone mass density (BMD) reduced. We examined whether vitamin D supplementation improves bone recovery in thyrotoxicosis caused by Graves' disease (GD).
METHODS
Using a double-blinded design, hyperthyroid patients with GD were randomized to vitamin D3 70 µg/day (2800 IU) or similar placebo as add-on to antithyroid drugs (ATD). At baseline and 9 months, we measured BMD and bone architecture using DXA and high resolution peripheral quantitative computerized tomography. Bone turnover markers (BTM) were measured at 3 months also. Effect of vitamin D versus placebo and the response to ATD treatment were analyzed using linear mixed modelling.
RESULTS
Eighty-six GD patients were included (age 41 ± 14 years, 86% females). Compared to placebo, vitamin D3 did not improve BMD or microarchitecture. In response to ATD, BMD increased in the hip by 2% (95%CI: 1-4%). Cortical porosity decreased in tibia (- 7% [95%CI: - 12 to - 2%]) and radius [- 14% [95%CI: - 24 to - 3%]), and trabecular thickness increased (tibia (5% [95%CI: 2 - 9%]) and radius (4% [95%CI: 1-7%]). Changes in BTM, but not thyroid hormones, were associated with changes in BMD by DXA and with changes in the cortical compartment.
CONCLUSION
In newly diagnosed GD, 9 months of high dose vitamin D3 supplementation does not offer benefit by improving skeletal health. Treatment of thyrotoxicosis is associated with the recovery of BMD and microarchitecture.
GOV IDENTIFIER
NCT02384668.
© 2024. The Author(s).
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