Risk of Osteoporotic Fractures among Patients with Thyroid Cancer: A Nationwide Population-Based Cohort Study

• Published in: Endocrinology and metabolism (Seoul) Vol. 40; no. 2; pp. 225 - 235
• Main Authors: Ku, Eu Jeong, Yoo, Won Sang, Hwang, Yu Been, Jang, Subin, Lee, Jooyoung, Moon, Shinje, Lee, Eun Kyung, Ahn, Hwa Young
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Endocrine Society 01.04.2025; 대한내분비학회
• Subjects: Adult; Aged; Aged, 80 and over; Case-Control Studies; Female; Follow-Up Studies; fractures; Humans; Male; Middle Aged; Original; osteoporosis; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - etiology; Prognosis; Republic of Korea - epidemiology; Retrospective Studies; Risk Factors; thyroid neoplasm; Thyroid Neoplasms - complications; Thyroid Neoplasms - epidemiology; Thyroxine - administration & dosage; Thyroxine - therapeutic use; 내과학; Republic of Korea; Osteoporosis; Thyroid neoplasm; Fractures
• ISSN: 2093-596X; 2093-5978; 2093-5978
• DOI: 10.3803/EnM.2024.2101

Background: The associations between thyroid cancer and skeletal outcomes have not been thoroughly investigated. We aimed to investigate the risk of osteoporotic fractures in patients with thyroid cancer compared to that in a matched control group.Methods: This retrospective cohort study included 2,514 patients with thyroid cancer and 75,420 matched controls from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC, 2006–2019). The rates of osteoporotic fractures were analyzed, and associations with the levothyroxine dose were evaluated.Results: Patients with thyroid cancer had a significantly lower risk of fracture than did the control group (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.69 to 0.94; P=0.006). Patients diagnosed with thyroid cancer after the age of 50 years (older cancer group) had a significantly lower risk of fracture than did those in the control group (HR, 0.72; 95% CI, 0.6 to 0.85; P<0.001), especially those diagnosed with spinal fractures (HR, 0.66; 95% CI, 0.51 to 0.85; P=0.001). Patients in the older cancer group started osteoporosis treatment earlier than did those in the control group (65.5±7.5 years vs. 67.3±7.6 years, P<0.001). Additionally, a lower dose of levothyroxine was associated with a reduced risk of fractures.Conclusion: In the clinical setting, the risk of fracture in women diagnosed with thyroid cancer after the age of 50 years was lower than that in the control group, which was caused by more proactive osteoporosis treatment in postmenopausal women with thyroid cancer.