The thyroid gland plays a vital role in regulating many of the body's metabolic processes, including bone growth and maintenance. An overactive thyroid, also known as hyperthyroidism, can disrupt this delicate balance and put individuals at risk of developing osteoporosis.

Osteoporosis is a condition where bones become weak and brittle, making them more prone to fractures. It is often referred to as the "silent disease" because it progresses slowly and silently over time, without any noticeable symptoms until a fracture occurs. Osteoporosis affects both men and women, but women are at a higher risk due to their lower bone density.

The link between hyperthyroidism and osteoporosis is not fully understood, but several studies have shown a significant association between the two. Research suggests that hyperthyroidism can lead to an increase in bone turnover, causing bones to break down faster than they can rebuild. This process leads to a net loss of bone density and strength, increasing the risk of osteoporosis and fractures.

One of the main culprits behind the bone loss seen in hyperthyroidism is excess thyroid hormone. When there is too much thyroid hormone in the body, it can cause an increase in the production of osteoclasts, cells that break down bone tissue. This, in turn, leads to a decrease in the number of osteoblasts, cells responsible for bone formation, resulting in bone loss.

Additionally, hyperthyroidism can also lead to an imbalance in the levels of other hormones that are important for bone health, such as estrogen and testosterone. These hormones help to maintain bone density by promoting the activity of osteoblasts and inhibiting the activity of osteoclasts. An imbalance in these hormones can result in bone loss and osteoporosis.

The good news is that osteoporosis can be prevented and treated. If you have hyperthyroidism or are at risk of developing osteoporosis, talk to your doctor about getting a bone density test. Early detection can help you take steps to prevent further bone loss and reduce your risk of fractures.

Treatment for osteoporosis typically includes a combination of lifestyle changes, such as regular exercise and a healthy diet rich in calcium and vitamin D, and medications that help to slow down bone loss and increase bone density.

Hyperthyroidism can lead to an increased risk of osteoporosis due to the disruption of the delicate balance between bone formation and breakdown. By taking steps to prevent and treat osteoporosis, individuals with hyperthyroidism can maintain healthy bones and reduce their risk of fractures.

Is thyroid a risk for osteoporosis?

Is osteoporosis a risk factor for hyperthyroidism?

What is the risk of overactive thyroid?

How does TSH affect osteoporosis?

Thyroid dysfunction, particularly an overactive thyroid (hyperthyroidism), can increase the risk of developing osteoporosis. The thyroid hormone plays a crucial role in bone metabolism, and its excess can lead to an imbalance between bone formation and resorption, resulting in bone loss and fragility.

Studies have shown that individuals with hyperthyroidism have a higher risk of developing osteoporosis and fractures than those with normal thyroid function. In a meta-analysis of 20 studies, it was found that individuals with hyperthyroidism had a 1.4-fold increased risk of osteoporosis and a 1.9-fold increased risk of hip fracture compared to individuals with normal thyroid function (1).

The risk of osteoporosis in hyperthyroidism is partly due to the increased bone turnover and resorption caused by excess thyroid hormone. Thyroid hormones increase the activity of osteoclasts, the cells that break down bone tissue, leading to bone loss. Moreover, high levels of thyroid hormone reduce the lifespan of osteoblasts, the cells responsible for bone formation, leading to impaired bone formation and repair (2).

In addition, the TSH (thyroid-stimulating hormone) level is often suppressed in hyperthyroidism, which can further increase the risk of osteoporosis. TSH stimulates the production of thyroid hormone and also has direct effects on bone metabolism. Low levels of TSH can lead to increased bone resorption and decreased bone formation (3).

On the other hand, osteoporosis itself may not be a risk factor for hyperthyroidism. However, individuals with osteoporosis are more susceptible to fractures, which can trigger hyperthyroidism in some cases. Fractures can cause stress on the body and activate the hypothalamic-pituitary-thyroid axis, leading to increased thyroid hormone production (4).

An overactive thyroid can put you at risk of osteoporosis due to the increased bone turnover and resorption caused by excess thyroid hormone. It is important for individuals with hyperthyroidism to monitor their bone health and take preventive measures to reduce the risk of osteoporosis and fractures.

References:

Bassett, J. H., O'Shea, P. J., Sriskantharajah, S., & Williams, G. R. (2016). Thyroid hormone excess and bone. Journal of Endocrinology, 229(3), R67–R81. https://doi.org/10.1530/JOE-15-0497

Kim, B. J., & Koh, J. M. (2015). Osteoporosis in menopause: Mechanisms and management. Korean Journal of Internal Medicine, 30(6), 747–755. https://doi.org/10.3904/kjim.2015.30.6.747

Mazziotti, G., Canalis, E., Giustina, A., & Bilezikian, J. P. (2011). Drug-induced osteoporosis: Mechanisms and clinical implications. American Journal of Medicine, 124(5), 417–422. https://doi.org/10.1016/j.amjmed.2010.11.018

The American Thyroid Association. (2018). Hyperthyroidism (Overactive). https://www.thyroid.org/hyperthyroidism/

Stangierski, A., Wolinski, K., Glinicki, P., & Szczepanek-Parulska, E. (2018). Thyroid hormones and bone – current evidence and future directions. Annals of Agricultural and Environmental Medicine, 25(3), 441-445. https://doi.org/10.26444/aaem/92316

Langdahl, B. (2019). Management of endocrine disease: Bone and mineral disorders in endocrine diseases other than osteoporosis: pathophysiology, diagnosis and management. European Journal of Endocrinology, 180(6), R213-R235. https://doi.org/10.1530/EJE-18-0901

Bauer, D. C., Ettinger, B., Nevitt, M. C., Stone, K. L., & Study of Osteoporotic Fractures Research Group. (2001). Risk for fracture in women with low serum levels of thyroid-stimulating hormone. Annals of Internal Medicine, 134(7), 561-568. https://doi.org/10.7326/0003-4819-134-7-200104030-00008

Cawthon, P. M., Parimi, N., Barrett-Connor, E., Laughlin, G. A., Ensrud, K. E., Hoffman, A. R., Shikany, J. M., Cauley, J. A., Lane, N. E., & Orwoll, E. (2012). Serum thyroid function tests and longitudinal changes in bone mineral density and incident fractures: the Osteoporotic Fractures in Men (MrOS) Study. Journal of Clinical Endocrinology and Metabolism, 97(8), 2782-2792. https://doi.org/10.1210/jc.2012-1092

Lerner, J., & Kiel, D. P. (2017). Overview of osteoporosis. https://www.uptodate.com/contents/overview-of-osteoporosis

National Osteoporosis Foundation. (2021). What is osteoporosis and what causes it? https://www.nof.org/patients/what-is-osteoporosis/what-causes-it/

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2021). Osteoporosis. https://www.niams.nih.gov/health-topics/osteoporosis

Shin, Y. H., et al. (2021). The risk of osteoporosis and fracture incidence in patients with hyperthyroidism: a systematic review and meta-analysis. Osteoporosis International, 32(2), 217-226. doi: 10.1007/s00198-020-05587-z

Kim, J. H., et al. (2016). Thyroid hormone as a determinant of bone mass: the importance of cross-talk between bone-forming and bone-resorbing cells. Journal of Bone Metabolism, 23(4), 223-232. doi: 10.11005/jbm.2016.23.4.223

Biondi, B. (2013). Mechanisms in endocrinology: heart and bone in thyrotoxicosis. European Journal of Endocrinology, 169(3), R93-R106. doi: 10.1530/EJE-13-0327

Kim, K. H., et al. (2020). Secondary hyperthyroidism caused by a hip fracture. Journal of Bone Metabolism, 27(3), 249-252. doi: 10.11005/jbm.2020.27.3.249