Review article

https://doi.org/10.20471/acc.2022.61.03.15

Impact of Graves’ Disease and Antithyroid Drug Therapy on Bone Mineral Density – Pathophysiological Mechanisms and Clinical Relevance

Dunja Mudri ; Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; Clinical Institute of Nuclear Medicine and Radiation Protection, University Hospital Centre Osijek, Croatia
Tomislav Kizivat ; Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; Clinical Institute of Nuclear Medicine and Radiation Protection, University Hospital Centre Osijek, Croatia
Martina Smolić ; Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University, Osijek, Croatia
Ivica Mihaljević ; Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; Clinical Institute of Nuclear Medicine and Radiation Protection, University Hospital Centre Osijek, Croatia
Robert Smolić ; Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University, Osijek, Croatia
Nikola Raguž Lučić ; Faculty of Dental Medicine and Health Osijek Josip Juraj Strossmayer University, Osijek, Croatia
Ines Bilić-Ćurčić orcid.org/0000-0002-8861-5987 ; Faculty of Medicine, Josip Juraj Strossmayer University, Osijek Croatia; Clinical Department of Endocrinology and Metabolism Disorders, University Hospital Centre Osijek, Osijek, Croatia

Abstract

Graves’ disease is an autoimmune disease characterized by excessive thyroid hormone
production. One of the consequences of that state can be a decrease in bone mineral density (BMD).
Graves’ disease is often treated with antithyroid drugs (ATD) as first line therapy, which can lead to disease
remission. Moreover, recent data show that improvement in BMD can be expected. However, vitamin D
deficiency can coexist along with Graves’ disease, which is also involved in the process of bone remodeling.
It is still not known whether lower values of vitamin D can contribute to onset of Graves’ disease and if its
supplementation might be helpful in therapy for hyperthyroidism. In the past couple of decades, osteopenia
and osteoporosis have become a major health burden not only in post-menopausal women but also as a result
of other diseases, leading to extensive research into various pathophysiological mechanisms responsible
for bone remodeling. The Wnt (wingless integrated) signaling pathway is a very important factor in bone
homeostasis, especially the canonical pathway. Present data indicate that stimulation of the Wnt pathway
leads to bone mass increase and, in contrast, its inhibition leads to bone mass decrease. Hence, inhibitors of
the canonical Wnt pathway became the focus of interest, in particular sclerostin and dickkopf 1 (DKK1).
Hyperthyroidism and osteopenia/osteoporosis are quite common today and can coexist together or as separate
entities. In this article, we aimed to give an overview of possible associations and potential mutual
pathophysiological mechanisms.

Keywords

Graves’ disease; Bone Mineral Density; Wnt Signaling Pathway; Sclerostin; Dickkopf 1

Hrčak ID:

296156

URI

https://hrcak.srce.hr/296156

Publication date:

1.11.2022.

Article data in other languages: croatian

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