Why do people who suffer from this thyroid condition often develop bone problems later in life?
Most importantly:
- Thyroid disorders and osteoporosis often affect older patients, particularly postmenopausal women.
- Hypothyroidism can increase the risk of osteoporosis due to a slowed rate of bone turnover and increased thyroid hormone intake.
- Treatment for hypothyroidism and osteoporosis requires an individualised approach and continuous monitoring to prevent a deterioration in bone density.
Osteoporosis is a disease characterised by low bone density and is often a cause of fractures and breaks as one gets older.
This is particularly true for postmenopausal women, and the risk increases further with age. Over 70% of people over the age of 80 have osteoporosis – that's over 200 million people worldwide.
Hypothyroidism is a reduced function of the thyroid gland – a chronic condition in which the thyroid gland does not produce enough thyroid hormones – mainly thyroxine (T4) and triiodothyronine (T3). These hormones regulate many vital processes in the body, including metabolism, thermoregulation, heart function, and even mental health. When their levels are low, the whole body functions "in slow motion", which manifests through symptoms such as chronic fatigue, weight gain and others. The condition can be caused by autoimmune conditions such as Hashimoto's thyroiditis, surgical removal of the gland, iodine deficiency, or as a side effect of certain medications.
People who suffer from hypothyroidism and other thyroid disorders are more susceptible to developing osteoporosis. In cases of marked hypofunction, reduced bone turnover is observed, meaning that the process of renewing bone tissue is slowed. As a result, although bone density does not immediately decrease, the bones become more brittle and less resistant to stress. Some studies also suggest that the lipid metabolism disturbances in hypothyroidism, including elevated triglycerides, may indirectly negatively affect bone density.
Taking too much thyroid medication for hypothyroidism can also lead to osteoporosis. According to the American Thyroid Association, there are two ways in which thyroid hormones can affect bones and cause loss of bone mass:
- an excessive amount of thyroid hormone due to hyperthyroidism
- excessive doses of medication for treating hypothyroidism, leading to high levels of hormones in the blood.
Who is at risk of hypothyroidism or osteoporosis?
Risk factors for hypothyroidism include:
- age – the likelihood of thyroid disease increases with age
- female sex – women are more susceptible to thyroid problems than men
- a previous medical history related to the thyroid gland (goitre, surgery, radiation)
- family history of thyroid disease
- Recent pregnancy
- diseases such as diabetes, anaemia, lupus, arthritis, coeliac disease, Sjögren's syndrome.
Risk factors for developing osteoporosis include:
- advanced age, especially after the menopause
Menopause itself increases the risk of osteoporosis due to the drastic reduction in oestrogen levels, a hormone that maintains bone density. When this is combined with hypothyroidism, the risk is doubled
- use of certain medications (antiepileptics and glucocorticoids)
- diseases such as chronic kidney failure, Cushing's disease, anorexia, malabsorption syndromes, low body weight, early menopause
- lifestyle (smoking, lack of exercise).
What are the symptoms of hypothyroidism?
Symptoms can be varied and often develop slowly, which makes them difficult to recognise early. One of the most common signs is weight gain, as the metabolism is slowed.
Another typical symptom is persistent exhaustion and fatigue, which is not alleviated even by prolonged rest. Many people also experience cold sensitivity – a feeling of cold due to impaired thermoregulation in the body with low levels of thyroid hormones.
Other common symptoms include depression, a slow heart rate (bradycardia), muscle and joint aches, dry skin, and hair thinning. Women often report irregular or heavy periods, and in severe cases, infertility can also occur.
To make an accurate diagnosis, in addition to assessing symptoms and consulting an endocrinologist, the most important part of the diagnostic process is laboratory testing for the hormones TSH (thyrotropin) and free T4 (thyroxine). Elevated levels of TSH in combination with low levels of T4 confirm the diagnosis of hypothyroidism.
What is the treatment for people with hypothyroidism and osteoporosis?
The treatment of patients who suffer from both hypothyroidism and osteoporosis requires a precise and individualised approach. For hypothyroidism, the main therapy involves taking levothyroxine, a synthetic form of the hormone thyroxine (T4), which compensates for the deficiency of the thyroid gland's natural hormones. Treatment typically starts with a low dose, which is gradually adjusted according to the patient's individual needs and the results of regular blood tests for TSH and free T4 levels.
Additionally, various non-hormonal products can be added to support the gland's function. One such product is Sarita+, created specifically to alleviate the symptoms of hypothyroidism such as fatigue, depression, weight gain, and lack of energy. The Sarita+ formula supports normal thyroid function and helps to restore hormonal balance, whilst promoting better metabolism and an overall sense of vitality.
On the other hand, the treatment of osteoporosis involves a combination of medication, dietary supplements and a diet that provides sufficient calcium and vitamin D, as well as physical activity. Bisphosphonates, drugs that slow the breakdown of bones, are often prescribed. In some cases, hormone therapies or newer biologic drugs that stimulate the formation of new bone tissue are also used.
Early diagnosis through tests such as densitometry (DXA scan), which measures bone density, is also crucial. Combined treatment of both diseases through the joint efforts of an endocrinologist and a rheumatologist/orthopaedic surgeon significantly improves the prognosis and quality of life for patients.
What does a diagnosis of osteoporosis risk mean?
A diagnosis of thyroid disease, particularly if it involves hormone replacement therapy, is essential for assessing the risk of osteoporosis. Research shows that long-term use of levothyroxine, especially at higher doses, can accelerate bone breakdown and increase the frequency of fractures in older patients. Even when laboratory values remain "normal", bone density can gradually decrease.
To avoid such consequences, it is important for patients to undergo regular screening not only for hormone levels but also for bone mineral density using specialised tests such as a DXA scan. This can help to identify the early signs of reduced bone mass and allow for preventive measures to be taken, such as adjusting treatment and adding medications to maintain bone health.
In conclusion:
The link between hypothyroidism and osteoporosis is real and significant, particularly in postmenopausal women, where hormonal imbalances and age-related changes exacerbate the negative impact on bone density. A slowed metabolism, poor bone regeneration, and potential thyroid hormone overdose make patients more susceptible to fractures and bone complications. Timely diagnosis, appropriate therapy, and combining this with suitable dietary supplements and physical activity are extremely important. Prevention through regular check-ups and a comprehensive approach to treatment can not only reduce the risk of osteoporosis but also significantly improve the quality of life for those affected.
