J Prev Med Public Health.
2014 Jan;47(1):36-46.
Levothyroxine Dose and Fracture Risk According to the Osteoporosis Status in Elderly Women
- Affiliations
-
- 1Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea. bjpark@snu.ac.kr
- 2Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea.
- 3Department of Family Medicine, Hallym University College of Medicine, Chuncheon, Korea.
- 4Department of Family Medicine, Health Promotion Center, Seoul National University Bundang Hospital, Seongnam, Korea.
- 5Korea Institute of Drug Safety and Risk Management, Seoul, Korea.
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 > or =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: < or =50 microg/d, 51 to 100 microg/d, 101 to 150 microg/d, and >150 microg/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 microg/d group, compared with the 51 to 100 microg/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 microg/d group, compared with the 51 to 100 microg/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.
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