Randomized trial of pamidronate in patients with thyroid cancer: Bone density is not reduced by suppressive doses of thyroxine, but is increased by cyclic intravenous pamidronate

被引:48
作者
Rosen, HN
Moses, AC
Garber, J
Ross, DS
Lee, SL
Ferguson, L
Chen, V
Lee, K
Greenspan, SL
机构
[1] Beth Israel Deaconess Med Ctr, Div Bone & Mineral Metab, Dept Med, Boston, MA 02215 USA
[2] Beth Israel Deaconess Med Ctr, Charles A Dana Res Inst, Boston, MA 02215 USA
[3] Beth Israel Deaconess Med Ctr, Harvard Thorndike Lab, Boston, MA 02215 USA
[4] Beth Israel Deaconess Med Ctr, Dept Med, Div Gerontol, Boston, MA 02215 USA
[5] Beth Israel Deaconess Med Ctr, Dept Med, Div Endocrinol, Boston, MA 02215 USA
[6] Harvard Pilgrim HealthCare, Endocrinol Sect, Hlth Ctr Div, Boston, MA 02215 USA
[7] Massachusetts Gen Hosp, Dept Med, Thyroid Unit, Boston, MA 02114 USA
[8] Tufts Univ New England Med Ctr, Endocrinol Diabet Metab & Mol Med Div, Dept Med, Boston, MA 02111 USA
关键词
D O I
10.1210/jc.83.7.2324
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Patients taking suppressive doses of T-4 are thought to have accelerated bone loss and increased risk of osteoporosis. We therefore randomize 55 patients taking suppressive doses of T-4 to treatment with pamidronate (APD) 30 mg iv every 3 months for 2 yr (APD/T-4), or placebo (placebo/T-4). Patients had measurements of bone mineral density (BMD) of the spine, hip, radius, and total body every 6 months for 2 yr. There was no significant bone loss at any site in the placebo/T-4 group. Ninety five percent confidence intervals excluded a rate of bone loss >0.89%/yr for the spine and >0.31%/yr at the total hip. When men were excluded from the analysis, there still was no significant bone loss for the placebo/T-4 group, and confidence intervals did not change. The APD/T-4 group showed increases in spine (4.3%, P = 0.0001), total hip (1.4%, P < 0.05), and trochanteric (3.0%, P = 0.0001) BMDs. In conclusion, premenopausal women and men on suppressive therapy with T-4 do not lose bone rapidly, and are not at increased risk of developing osteoporosis. A regimen of 30 mg APD given every 3 months for 2 yr causes significant suppression of bone resorption and increases in BMD, and maybe an acceptable alternative treatment for osteoporosis in patients who cannot tolerate oral bisphosphonates.
引用
收藏
页码:2324 / 2330
页数:7
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