Long-term treatment with supraphysiological doses of thyroid hormone in affective disorders — effects on bone mineral density

Ricken, Roland; Bermpohl, Felix; Schlattmann, Peter; Bschor, Tom; Adli, Mazda; Mönter, Norbert; Bauer, Michael

doi:10.1016/j.jad.2011.06.011

« Previous Next »Journal of Affective Disorders
Volume 136, Issue 1 , Pages e89-e94, January 2012

Long-term treatment with supraphysiological doses of thyroid hormone in affective disorders — effects on bone mineral density

Roland Ricken
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
- Berlin School of Mind and Brain, Berlin, Germany
Peter Schlattmann
- Department of Medical Statistics, Informatics and Documentation, University Hospital of Friedrich-Schiller University Jena, Jena, Germany
Tom Bschor
- Department of Psychiatry and Psychotherapy, Schloßparkklinik, Berlin, Germany
Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
Norbert Mönter
- Nervenärztlich Psychotherapeutische Praxisgemeinschaft, Tegeler Weg 4; 10589 Berlin, Germany
Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Corresponding author at: Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr, 74, D-01307 Dresden, Germany. Tel.: +49 351 458 2772; fax: +49 351 458 4324.

Received 9 December 2010; received in revised form 10 June 2011; accepted 11 June 2011.

Abstract

Background

To investigate the long-term effects of supraphysiological, TSH suppressive doses of levothyroxine (TSDL) on bone mineral density (BMD) in patients with affective disorders during an average treatment duration of 69months.

Methods

In 22 patients, BMD of the spine (lumbar vertebrae L1–4) and femur (femoral neck) was measured by dual energy X-ray absorptiometry (DXA). Forty (40) measurements from the prior study and 48 new follow-up measurements were included. BMD was expressed as Z-scores as a population standard reference. We used a linear mixed model to investigate the duration of TSDL as an explanatory factor for change in BMD compared to an age and gender matched reference population.

Results

We found no significant differences in bone loss between the study and the reference population. The estimated non-significant decrease in Z-score compared to the reference population found was: a) lumbar spine (L1–4): −0.00069/month (p=0.9759) b) neck region of femur: −0.01405/month (p=0.4436). We did not find the factors age, thyroxine-dose or postmenopausal state as predictors for a decline in BMD.

Limitations

Small sample size, no bone density assessment prior to treatment with TSDL, no patient control group with mood disorders who did not receive TSDL, variable bone density follow-up intervals.

Conclusion

This study did not demonstrate evidence that long-term treatment of affectively ill patients with TSDL accelerates loss of BMD compared to an age- and gender-matched reference population.

Keywords: Levothyroxine, Bone mineral density, Dual energy X-ray, Absorptiometry, Prophylaxis, Affective disorders