Download PDF
Exp Clin Endocrinol Diabetes 2004; 112(8): 444-450
DOI: 10.1055/s-2004-821204
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Impact of Parathyroid Status and Ca and Vitamin-D Supplementation on Bone Mass and Muscle-Bone Relationships in 208 Belarussian Children after Thyroidectomy because of Thyroid Carcinoma[1]

P. Schneider1 , J. Biko1 , Chr. Reiners1 , Y. E. Demidchik2 , V. M. Drozd3 , R. F. Capozza4 , G. R. Cointry4 , J. L. Ferretti4
  • 1Clinic for Nuclear Medicine, University of Würzburg, Würzburg, Germany
  • 2Center of Thyroid Cancer, Minsk, Belarus
  • 3Institute of Radiation Medicine and Endocrinology, Minsk, Belarus
  • 4Centre for P-Ca Metabolism Studies (CEMFoC), National University of Rosario, Rosario, Argentina
Further Information

Publication History

Publication Date:
16 September 2004 (online)

Also available at
    Permissions and Reprints

Abstract

This observational study analyzes Ca-P metabolism and its impact on bone mass accrual and density and the muscle-bone mass/mass relationships in male and female children and adolescents who were parathyroidectomized because of thyroid carcinoma.

Two hundred and eight children and adolescents (119 girls and 89 boys) from Gomel city (Belarus) and its rural surroundings were referred to our institution after having undergone total thyroidectomy for the treatment of advanced papillary thyroid cancer. A subgroup of children with demonstrated primary hypoparathyroidism received dihydrotachysterol (AT-10) and/or Ca supplementation. Among routine procedures over a maximum follow-up period of 5 years (average 3.7 years, maximum 8 visits), whole-body scans were taken using dual energy X-ray absorptiometry (DXA) at each visit in order to determine whole-body bone mineral content (TBMC), projected “areal” bone mineral density (TBMD), total lean mass (TLM) and total fat mass (TFM).

The average serum Ca, P and AP concentrations over the whole observation period were significantly different between the groups; however, TBMC z-scores for all studied children were statistically similar in all visits. In girls, no between-group differences in height- and weight-controlled TBMC and TBMD or the TBMC/TLM ratio were observed (ANCOVA) and supplementation exerted no effect on these data, suggesting that the total bone mass accrual was not impaired by PTH deficiency in the studied conditions. However, non-supplemented boys showed lower values of the TBMC/TLM ratio than girls, and supplementation normalized these values in direct correlation with the induced improvement in serum P availability to bone.

Results indicate that the primary impairment in parathyroid function and bone metabolism indicators in the thyroidectomized children was unrelated to any measurable change in crude bone mass values. However, in boys this condition impaired the TBMC/TLM ratio in such a way that the administered supplementation could normalize it as a function of improved P availability. Girls' skeleton seemed to have been naturally protected against the negative metabolic effect of the studied condition. An estrogen-induced enhancement of the biomechanical impact of muscle contractions on bone mass and structure could not be excluded in this group.

Key words

Bone mineral mass - lean body mass - thyroid cancer - hypoparathyroidism - adolescence - muscle-bone relationships - whole-body densitometry - calcium supplementation - vitamin D

1 Dedicated to Harold M. Frost who recently passed. We lost a great bone biologist and friend.

References

  • 1 Abugassa S, Nordenstrom J, Eriksson S, Sjoden G. Bone mineral density in patients with chronic hypoparathyroidism.  J Clin Endocrinol Metab. 1993;  76 1617-1621
    CrossrefPubMedGoogle Scholar
  • 2 Bassey E J, Rothwell M C, Littlewood J J, Pye D W. Pre- and post-menopausal women have different bone mineral density responses to the same high-impact exercise.  J Bone Miner Res. 1998;  13 1805-1813
    CrossrefPubMedGoogle Scholar
  • 3 Chan F KW, Tiu S C, Choi K L, Choi C H, Kong A PS, Shek C C. Increased bone mineral density in patients with chronic hypoparathyroidism.  J Clin Endocrinol Metab. 2003;  88 3155-3159
    CrossrefPubMedGoogle Scholar
  • 4 Chen Q, Kaji H, Iu M F, Nomura R, Sowa H, Yamauchi M, Tsukamoto T, Sugimoto T, Chihara K. Effects of an excess and a deficiency of endogenous parathyroid hormone on volumetric bone mineral density and bone geometry determined by peripheral quantitative computed tomography in female subjects.  J Clin Endocrinol Metab. 2003;  88 4655-4658
    CrossrefPubMedGoogle Scholar
  • 5 Cheng S, Sipilä S, Taaffe D R, Puolakka J, Suominen H. Change in bone mass distribution induced by hormone replacement therapy and high-impact physical exercise in post-menopausal women.  Bone. 2002;  31 126-135
    CrossrefPubMedGoogle Scholar
  • 6 Cointry G R, Capozza R F, Negri A L, Roldan E JA, Ferretti J L. Biomechanical background for a noninvasive assessment of bone strength and muscle-bone interaction.  J Musculoskel Interact. 2004;  4 1-11
    PubMedGoogle Scholar
  • 7 Dietlein M, Dressler J, Joseph K, Leisner B, Moser E, Reiners C, Schicha H, Schober O. Leitlinie zur Radioiodtherapie (RIT) beim differenzierten Schilddrüsenkarzinom.  Nucl Med. 1999;  38 221-222
    PubMedGoogle Scholar
  • 8 Ellis K J, Shypailo R J, Pratt J A, Pond W G. Accuracy of dual-energy X-ray absorptiometry for body composition measurements in children.  Am J Clin Nutr. 1994;  60 660-665
    PubMedGoogle Scholar
  • 9 Ferretti J L, Capozza R F, Cointry G R, Garcia S L, Plotkin H, Filgueira M LA, Zanchetta J R. Gender-related differences in the relationship between densitometric values of whole-body bone mineral content and lean body mass in humans between 2 and 87 years of age.  Bone. 1998;  22 683-690
    CrossrefPubMedGoogle Scholar
  • 10 Ferretti J L, Cointry G R, Capozza R F, Frost H M. Bone mass, bone strength, muscle-interactions, osteopenias and osteoporosis.  Bone. 2003;  124 269-279
    PubMedGoogle Scholar
  • 14 Frost H M, Jee W SS. “Osteoporosis” in 2000 AD: quo vadis?.  J Musculoskeletal Res. 2001;  5 1-16
    PubMedGoogle Scholar
  • 11 Ghatge K D, Lambert H L, Barker M E, Eastell R. Bone mineral gain following calcium supplementation in teenage girls is reversed two years after withdrawal of the supplement.  JBMR. 2001;  16 S173
    PubMedGoogle Scholar
  • 12 Heymsfield S B, Smith R, Aulet M. et al . Appendicular skeletal muscle mass: Measurement by dual-photon absorptiometry.  Am J Clin Nutr. 1990;  52 214-218
    PubMedGoogle Scholar
  • 13 Hundahl S A, Cady B, Cunningham M P, Mazzaferri E, McKee R F, Rosai J, Shah J P, Fremgen A M, Stewart A K, Holzer S. Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the United States during 1996. U. S. and German Thyroid Cancer Study Group. An American College of Surgeons Commission on Cancer Patient Care Evaluation study.  Cancer. 2000;  89 202-217
    CrossrefPubMedGoogle Scholar
  • 15 Mazess R B, Barden H S, Bisek J P, Hanson J. Dual-energy X-ray absorptiometry for total-body and regional bone mineral and soft-tissue composition.  Am J Clin Nutr. 1990;  51 1106-1112
    CrossrefPubMedGoogle Scholar
  • 16 Molgaard C, Thomsen L, Prentice A, Cole T J, Michael K F. Whole body bone mineral content in healthy children and adolescents.  Arch Dis Child. 1997;  76 9-15
    PubMedGoogle Scholar
  • 17 Myburgh K H, Charette S, Zhou L, Steele C R, Arnaud S, Marcus R. Influence of recreational activity and muscle strength on ulnar bending stiffness in men.  Med Sci Sports Exerc. 1993;  25 592-596
    PubMedGoogle Scholar
  • 18 Pearson J. et al . European semi-anthropomorphic spine phantom for the calibration of bone densitometers: Assessment of precision, stability and accuracy. The European Quantitation of Osteoporosis Study Group.  Osteoporosis International. 1995;  5 174-184
    PubMedGoogle Scholar
  • 19 Poesmans W, Goos G, Emma F, Geusens P, Nijs J, Dequeker J. Total body mineral mass measured with dual photon absorptiometry in healthy children.  Eur J Pediatr. 1994;  153 807-812
    CrossrefPubMedGoogle Scholar
  • 20 Reiners C, Biko J, Farahati J, Kirinjuk S D, Kruglova N, Demidchik E P. Results of radioiodine treatment in 158 children from Belarus with thyroid cancer after the Chernobyl accident.  Int J Rad Med. 1999;  3 47-50
    PubMedGoogle Scholar
  • 21 Reiners C, Biko J, Demidchik E P, Drozd V. Thyroid cancer after exposure to ionizing radiation: histology, staging and clinical data. Peter F, Wiersinga W, Hostalek U Merck European Thyroid Symposium Budapest 2000. Stuttgart, New York; Schattauer 2000: 193
    Google Scholar
  • 22 Schneider P, Berger P, Kruse K, Börner W. Effect of calcitonin deficiency on bone density and bone turnover in totally thyroidectomized patients.  J Endocr Invest. 1991;  14 935-942
    PubMedGoogle Scholar
  • 23 Schneider P, Biko J, Schlamp D, Trott G E, Badura F, Warnke A, Reiners C. Comparison of total and regional body composition in adolescent patients with anorexia nervosa and pair-matched controls.  Eating Weight Disord. 1998;  3 179-187
    PubMedGoogle Scholar
  • 24 Schneider R, Reiners C. The effect of levothyroxine therapy on bone mineral density: A systematic review of the literature.  Exp Clin Endo Diab. 2003;  111 455-470
    PubMedGoogle Scholar
  • 25 Schönau E, Neu C M, Rauch F, Manz F. The development of bone strength at the proximal radius during childhood and adolescence.  J Clin Endocrinol Metab. 2000;  86 613-618
    PubMedGoogle Scholar
  • 26 Van der Sluis I M, de Ridder M AJ, Boot A M, Krenning E P, de Muinck Keizer-Schrama S MPF. Reference data for bone density and body composition measured with dual energy X ray absorptiometry in white children and young adults.  Arch Dis Child. 2002;  87 341-347
    CrossrefPubMedGoogle Scholar
  • 27 Villa M L, Marcus R, Ramírez Delay R, Kelsey J L. Factors contributing to skeletal health of postmenopausal Mexican-American women.  J Bone Miner Res. 1995;  10 1233-1242
    PubMedGoogle Scholar
  • 28 Visser M, Deeg D JH, Lips P. Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam.  J Clin Endocrinol Metab. 2003;  88 5766-5772
    CrossrefPubMedGoogle Scholar
  • 29 Visser M, Fuerst T, Lang T, Salamone L, Harris T. Validity of fan-beam dual-energy X-ray absorptiometry for measuring the fat-free mass and leg muscle mass.  J Appl Physiol. 1999;  87 1513-1520
    PubMedGoogle Scholar
  • 30 Wang W, Wang Z, Faith M S, Kotler D, Shih R, Heymsfield S B. Regional skeletal muscle measurement: Evaluation of a new dual-energy X-ray absorptiometric model.  J Appl Physiol. 1999;  87 1163-1171
    PubMedGoogle Scholar
  • 31 Zanchetta J R, Plotkin H, Alvarez-Figueira M L. Bone mass in children: Normative values for the 2 - 20-year-old population.  Bone. 1995;  16 393-399
    PubMedGoogle Scholar

1 Dedicated to Harold M. Frost who recently passed. We lost a great bone biologist and friend.

Prof. Dr. Peter Schneider

Clinic for Nuclear Medicine

Josef-Schneider-Str. 2

97080 Würzburg

Germany

Phone: + 4993120135873

Fax: + 49 9 31 20 13 52 47

Email: schneider_P@nuklearmedizin.uni-wuerzburg.de

      >