Risk of Osteoporosis and Fractures in Patients with Thyroid Cancer: A Caseâ Control Study in U.S. Veterans

BackgroundData on osteoporosis and fractures in patients with thyroid cancer, especially men, are conflicting. Our objective was to determine osteoporosis and fracture risk in U.S. veterans with thyroid cancer.Materials and MethodsThis is a caseâ control study using the Veterans Health Administration Corporate Data Warehouse (2004â 2013). Patients with thyroid cancer (n = 10,370) and controls (n = 10,370) were matched by age, sex, weight, and steroid use. Generalized linear mixedâ effects regression model was used to compare the two groups in terms of osteoporosis and fracture risk. Next, subgroup analysis of the patients with thyroid cancer using longitudinal thyroidâ stimulating hormone (TSH) was performed to determine its effect on risk of osteoporosis and fractures. Other covariates included patient age, sex, median household income, comorbidities, and steroid and androgen use.ResultsCompared with controls, osteoporosis, but not fractures, was more frequent in patients with thyroid cancer (7.3% vs. 5.3%; odds ratio [OR], 1.33; 95% confidence interval [CI], 1.18â 1.49) when controlling for median household income, Charlson/Deyo comorbidity score, and androgen use. Subgroup analysis of patients with thyroid cancer demonstrated that lower TSH (OR, 0.93; 95% CI, 0.90â 0.97), female sex (OR, 4.24; 95% CI, 3.53â 5.10), older age (e.g., â ¥85 years: OR, 17.18; 95% CI, 11.12â 26.54 compared with