Levothyroxine Dose and Fracture Risk According to the Osteoporosis Status in Elderly Women.
- Author:
Young Jin KO
1
;
Ji Young KIM
;
Joongyub LEE
;
Hong Ji SONG
;
Ju Young KIM
;
Nam Kyong CHOI
;
Byung Joo PARK
Author Information
1. Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea. bjpark@snu.ac.kr
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Thyroxine;
Fractures;
Cohort studies;
Aged;
Osteoporosis
- MeSH:
Aged;
Aged, 80 and over;
Cohort Studies;
Databases, Factual;
Female;
Fractures, Bone/*prevention & control;
Humans;
Hypothyroidism/diagnosis/drug therapy;
Insurance Claim Review;
Medication Adherence;
Osteoporosis/*pathology;
Proportional Hazards Models;
Risk Assessment;
Thyroxine/*therapeutic use;
Time Factors
- From:Journal of Preventive Medicine and Public Health
2014;47(1):36-46
- CountryRepublic of Korea
- Language:English
-
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.
