Skip to main content
SpringerLink
Log in

Fragilità scheletrica nel paziente con carcinoma differenziato della tiroide

  • RASSEGNA
  • Published:
L'Endocrinologo Aims and scope

Sommario

L’osteoporosi e le fratture da fragilità scheletrica rappresentano importanti comorbidità nei pazienti con carcinoma differenziato della tiroide (DTC), con potenziale impatto negativo sulla qualità di vita e sulla sopravvivenza. La terapia TSH-soppressiva rappresenta il principale determinante della fragilità scheletrica nei pazienti con DTC, favorendo il riassorbimento osseo e il deterioramento della microstruttura ossea. Tale effetto negativo può essere amplificato in presenza di metastasi ossee che incrementano ulteriormente il rischio di fratture. L’inquadramento e la gestione della fragilità scheletrica nel DTC sono ancora controverse e i dati sull’efficacia dei farmaci osteo-attivi in questo contesto clinico sono scarsi.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Bibliografia

  1. Haugen BR, Alexander EK, Bible KC et al. (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26(1):1–133

    Article  Google Scholar 

  2. Somwaru LL, Arnold AM, Joshi N et al. (2009) High frequency of and factors associated with thyroid hormone over-replacement and under-replacement in men and women aged 65 and over. J Clin Endocrinol Metab 94(4):1342–1345

    Article  CAS  Google Scholar 

  3. Iniguez-Ariza NM, Bible KC, Clarke BL (2020) Bone metastases in thyroid cancer. J Bone Oncol 21:100282

    PubMed  PubMed Central  Google Scholar 

  4. Raggatt LJ, Partridge NC (2010) Cellular and molecular mechanisms of bone remodeling. J Biol Chem 285(33):25103–25108

    Article  CAS  Google Scholar 

  5. Williams GR, Bassett JH (2018) Thyroid diseases and bone health. J Endocrinol Invest 41(1):99–109

    Article  CAS  Google Scholar 

  6. Abe E, Marians RC, Yu W et al. (2003) TSH is a negative regulator of skeletal remodeling. Cell 115(2):151–162

    Article  CAS  Google Scholar 

  7. Martini G, Gennari L, De Paola V et al. (2008) The effects of recombinant TSH on bone turnover markers and serum osteoprotegerin and RANKL levels. Thyroid 18(4):455–460

    Article  CAS  Google Scholar 

  8. Mazziotti G, Sorvillo F, Piscopo M et al. (2005) Recombinant human TSH modulates in vivo C-telopeptides of type-1 collagen and bone alkaline phosphatase, but not osteoprotegerin production in postmenopausal women monitored for differentiated thyroid carcinoma. J Bone Miner Res 20(3):480–486

    Article  CAS  Google Scholar 

  9. Hofbauer LC, Rachner TD, Coleman RE, Jakob F (2014) Endocrine aspects of bone metastases. Lancet Diabetes Endocrinol 2(6):500–512

    Article  CAS  Google Scholar 

  10. Karner I, Hrgovic Z, Sijanovic S et al. (2005) Bone mineral density changes and bone turnover in thyroid carcinoma patients treated with supraphysiologic doses of thyroxine. Eur J Med Res 10(11):480–488

    CAS  PubMed  Google Scholar 

  11. Toivonen J, Tahtela R, Laitinen K et al. (1998) Markers of bone turnover in patients with differentiated thyroid cancer with and following withdrawal of thyroxine suppressive therapy. Eur J Endocrinol 138(6):667–673

    Article  CAS  Google Scholar 

  12. Yoon BH, Lee Y, Oh HJ et al. (2019) Influence of thyroid-stimulating hormone suppression therapy on bone mineral density in patients with differentiated thyroid cancer: a meta-analysis. J Bone Metab 26(1):51–60

    PubMed  PubMed Central  Google Scholar 

  13. Zhu H, Zhang J, Wang J et al. (2020) Association of subclinical thyroid dysfunction with bone mineral density and fracture: a meta-analysis of prospective cohort studies. Endocrine 67(3):685–698

    Article  CAS  Google Scholar 

  14. Sugitani I, Fujimoto Y (2011) Effect of postoperative thyrotropin suppressive therapy on bone mineral density in patients with papillary thyroid carcinoma: a prospective controlled study. Surgery 150(6):1250–1257

    Article  Google Scholar 

  15. Wang LY, Smith AW, Palmer FL et al. (2015) Thyrotropin suppression increases the risk of osteoporosis without decreasing recurrence in ATA low- and intermediate-risk patients with differentiated thyroid carcinoma. Thyroid 25(3):300–307

    Article  CAS  Google Scholar 

  16. Tournis S, Antoniou JD, Liakou CG et al. (2015) Volumetric bone mineral density and bone geometry assessed by peripheral quantitative computed tomography in women with differentiated thyroid cancer under TSH suppression. Clin Endocrinol (Oxf) 82(2):197–204

    Article  Google Scholar 

  17. Moon JH, Kim KM, Oh TJ et al. (2017) The effect of TSH suppression on vertebral trabecular bone scores in patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab 102(1):78–85

    PubMed  Google Scholar 

  18. De Mingo Dominguez ML, Guadalix Iglesias S, Martin-Arriscado Arroba C et al. (2018) Low trabecular bone score in postmenopausal women with differentiated thyroid carcinoma after long-term TSH suppressive therapy. Endocrine 62(1):166–173

    Article  Google Scholar 

  19. Mazziotti G, Formenti AM, Frara S et al. (2018) High prevalence of radiological vertebral fractures in women on thyroid-stimulating hormone-suppressive therapy for thyroid carcinoma. J Clin Endocrinol Metab 103(3):956–964

    Article  Google Scholar 

  20. Cellini M, Rotondi M, Tanda ML et al. (2021) Skeletal health in patients with differentiated thyroid carcinoma. J Endocrinol Invest 44(3):431–442

    Article  CAS  Google Scholar 

  21. Schousboe JT, Shepherd JA, Bilezikian JP, Baim S (2013) Executive summary of the 2013 International Society for Clinical Densitometry Position Development Conference on bone densitometry. J Clin Densitom 16(4):455–466

    Article  Google Scholar 

  22. Panico A, Lupoli GA, Fonderico F et al. (2009) Osteoporosis and thyrotropin-suppressive therapy: reduced effectiveness of alendronate. Thyroid 19(5):437–442

    Article  CAS  Google Scholar 

  23. McCloskey EV, Odén A, Harvey NC et al. (2016) A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX. J Bone Miner Res 31(5):940–948

    Article  Google Scholar 

  24. Pacini F, Basolo F, Bellantone R et al. (2018) Italian consensus on diagnosis and treatment of differentiated thyroid cancer: joint statements of six Italian societies. J Endocrinol Invest 41(7):849–876

    Article  CAS  Google Scholar 

  25. Mazziotti G, Porcelli T, Patelli I et al. (2010) Serum TSH values and risk of vertebral fractures in euthyroid post-menopausal women with low bone mineral density. Bone 46(3):747–751

    Article  CAS  Google Scholar 

  26. Williams GR (2014) Is prophylactic anti-resorptive therapy required in thyroid cancer patients receiving TSH-suppressive treatment with thyroxine? J Endocrinol Invest 37(8):775–779

    Article  Google Scholar 

  27. Mazziotti G, Formenti AM, Panarotto MB et al. (2018) Real-life management and outcome of thyroid carcinoma-related bone metastases: results from a nationwide multicenter experience. Endocrine 59(1):90–101

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. S.O.C. di Endocrinologia, Malattie del Metabolismo e Nutrizione Clinica, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italia

    Miriam Cellini, Fabio Vescini & Franco Grimaldi

  2. Unità di Endocrinologia, Diabetologia e Andrologia Medica, Istituto Clinico Humanitas, Rozzano (MI); Dipartimento di Scienze Biomediche, Humanitas University di Milano, Milano, Italia

    Salvatore Ariano, Andrea G. Lania & Gherardo Mazziotti

Authors
  1. Miriam Cellini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Salvatore Ariano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabio Vescini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Franco Grimaldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea G. Lania
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gherardo Mazziotti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Miriam Cellini.

Ethics declarations

Conflitto di interesse

Gli autori Miriam Cellini, Salvatore Ariano, Fabio Vescini, Franco Grimaldi, Andrea G. Lania e Gherardo Mazziotti dichiarano di non avere conflitti di interesse.

Consenso informato

Lo studio presentato in questo articolo non ha richiesto sperimentazione umana. La paziente ha firmato il consenso per la pubblicazione delle immagini radiologiche.

Studi sugli animali

Gli autori di questo articolo non hanno eseguito studi sugli animali.

Additional information

Proposto da Gherardo Mazziotti.

Nota della casa editrice

Springer Nature rimane neutrale in riguardo alle rivendicazioni giurisdizionali nelle mappe pubblicate e nelle affiliazioni istituzionali.

Informazioni Supplementari

I link al materiale elettronico supplementare sono elencati qui sotto.

(DOC 31 kB)

(DOC 29 kB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cellini, M., Ariano, S., Vescini, F. et al. Fragilità scheletrica nel paziente con carcinoma differenziato della tiroide. L'Endocrinologo 22, 238–243 (2021). https://doi.org/10.1007/s40619-021-00866-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40619-021-00866-9

Parole chiave

Search

Navigation