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      Does Graves’ Disease during Puberty Influence Adult Bone Mineral Density?

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          Abstract

          Aim: To evaluate the bone mineral density at lumbar spine and at femoral neck in a group of young adults in whom Graves’ disease developed during childhood and adolescence. Patients and Methods: We examined 28 patients (5 male, 23 female, age 20.9 ± 3.3 years) who were 11.8 ± 2.9 years old at the onset of Graves’ disease. They were treated either with methimazole (14 patients) or with methimazole plus l-thyroxine (14 patients). At the time of the investigation, 13 patients were considered cured following antithyroid treatment, 2 were still on antithyroid drugs, 3 were on replacement therapy with l-thyroxine because of hypothyroidism, and 10, treated either surgically or with <sup>131</sup>I, were on replacement therapy. The bone mineral density was measured at the lumbar spine (L2–L4) and at the femoral neck, using dual-energy X-ray absorptiometry. Results: The spinal bone mineral density SD score was –0.28 ± 1.02, the femoral neck bone mineral density SD score was 0.36 ± 1.02, and both were not different from zero (NS). We did not find any correlation between the bone mineral density of the femoral neck and that of the lumbar spine and the clinical parameters. Conclusion: Graves’ disease, beginning in childhood and adolescence, when appropriately treated, does not affect attainment of peak bone mass.

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          Most cited references 2

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          Effect of hyperthyroidism and its treatment on bone mineral content.

           Sang Toh (1985)
          Patients with hyperthyroidism may develop osteopenia associated with fractures; however, there has been no general agreement on the incidence of osteopenia in hyperthyroidism or the recovery of the mineral loss after treatment of hyperthyroidism. We conducted a longitudinal prospective study on the effect of hyperthyroidism and its treatment on bone mineral content (BMC) using photon absorptiometry. We observed that both young and older hyperthyroid patients showed a significantly decreased baseline BMC compared with age- and sex-matched controls. We also observed a slight recovery of BMC in hyperthyroid patients at the two-year interval after a euthyroid state had been achieved. However, the BMC was still much lower than that of controls, and we did not find any significant restoration of BMC following "cure" of hyperthyroidism.
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            Reduced bone mineral density at diagnosis and bone mineral recovery during treatment in children with Graves' disease.

            In children with Graves' disease, the prevalence of osteopenia is unknown, and the possible restoration of bone mass by antithyroid treatment has not been evaluated. The aim of this study was to prospectively evaluate the bone mineral density (BMD) and bone metabolism at diagnosis and after 1 and 2 years of medical treatment. Twenty-six children (19 girls and 7 boys) aged 11 +/- 3.4 years (range 3.4 to 15.3 years) were studied. BMD of the lumbar spine and proximal femur were measured by dual-energy x-ray absorptiometry. Values were compared with those of healthy children of similar age, sex, and pubertal stage. At diagnosis the mean BMD (standard deviation score [SDS]) was significantly reduced in both sites (P <.001) with a preferential loss of cortical bone (femoral BMD = -1.7 +/- 1.0 SDS) rather than trabecular bone (lumbar spine BMD = -0.8 +/- 1.1 SDS) (P =.003). Severe osteopenia (below -2 SDS) was found in 11 (42%) of 26 patients. Osteocalcin was significantly higher than in the control group (P <.0001), but other bone metabolism markers were normal. During treatment (n = 19) a significant gain in femoral (F = 14.7; P =.001) and lumbar spine (F = 5; P =.02) BMD (SDS) was observed, and none of the patients showed osteopenia. The annual percent change in the BMD values at the femoral (+23% +/- 11% and +6% +/- 4%, respectively, during the first and second years) and lumbar spine (+19% +/- 9% and +6% +/- 5%, respectively, during the first and second years) sites was greater during the first year than during the second year of treatment (P <.02 for femoral, P <.04 for lumbar spine). No significant age difference in BMD SD score or in BMD percent change values was observed. Osteocalcin returned rapidly to normal values, and all other bone metabolism markers remained in the normal range. In conclusion, severe osteopenia was observed at diagnosis in children with Graves' disease but was rapidly corrected after 1 and 2 years of treatment. Initial reduced bone mass with high bone turnover caused by hyperthyroidism was corrected after 1 year of euthyroid conditions.
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              Author and article information

              Journal
              HRE
              Horm Res Paediatr
              10.1159/issn.1663-2818
              Hormone Research in Paediatrics
              S. Karger AG
              1663-2818
              1663-2826
              2002
              2002
              19 September 2002
              : 58
              : 4
              : 176-179
              Affiliations
              aDepartment of Pediatrics, Regional Hospital of Bolzano, bPediatric Unit, University of Novara, cDepartment of Pediatric Endocrinology, Ospedale Regina Margherita, Torino, dAuxology Unit, Bambino Gesù Children’s Hospital, IRCCS, Palidoro, eDepartment of Pediatrics, S. Anna Hospital, Ferrara, fPediatric Unit, University of Verona, and gPediatric Unit, University of Padua, Italy
              Article
              65491 Horm Res 2002;58:176–179
              10.1159/000065491
              12324715
              © 2002 S. Karger AG, Basel

              Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

              Page count
              Figures: 2, Tables: 1, References: 14, Pages: 4
              Categories
              Original Paper

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