Levothyroxine dose and fracture risk according to the osteoporosis status in elderly women

Young Jin Ko, Ji Young Kim, Joongyub Lee, Hong Ji Song, Ju Young Kim, Nam Kyong Choi, Byung Joo Park

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

Objectives: To evaluate the association between fracture risk and levothyroxine use in elderly women with hypothyroidism, according to previous osteoporosis history. Methods: We conducted a cohort study from the Korean Health Insurance Review and Assessment Service claims database from January 2005 to June 2006. The study population comprised women aged .65 years who had been diagnosed with hypothyroidism and prescribed levothyroxine monotherapy. We excluded patients who met any of the following criteria: previous fracture history, hyperthyroidism, thyroid cancer, or pituitary disorder; low levothyroxine adherence; or a follow-up period <90 days. We categorized the daily levothyroxine doses into 4 groups: .50 μg/d, 51 to 100 μg/d, 101 to 150 μg/d, and >150 μg/d. The hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with the Cox proportional hazard model, and subgroup analyses were performed according to the osteoporosis history and osteoporosis-specific drug prescription status. Results: Among 11 155 cohort participants, 35.6% had previous histories of osteoporosis. The adjusted HR of fracture for the >150 μg/d group, compared with the 51 to 100 μg/d group, was 1.56 (95% CI, 1.03 to 2.37) in osteoporosis subgroup. In the highly probable osteoporosis subgroup, restricted to patients who were concurrently prescribed osteoporosis-specific drugs, the adjusted HR of fracture for the >150 μg/d group, compared with the 51 to 100 μg/d group, was 1.93 (95% CI, 1.14 to 3.26). Conclusions: While further studies are needed, physicians should be concerned about potential levothyroxine overtreatment in elderly osteoporosis patients.

Original languageEnglish
Pages (from-to)36-46
Number of pages11
JournalJournal of Preventive Medicine and Public Health
Volume47
Issue number1
DOIs
StatePublished - Jan 2014

Keywords

  • Aged
  • Cohort studies
  • Fractures
  • Osteoporosis
  • Thyroxine

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