T4-only associated with increased fracture risk in elderly

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Levothyroxine Dosing Associated with Increased Fracture Risk in the Elderly Elderly patients receiving levothyroxine show a dose-related increased risk for fracture, according to a BMJ study. An accompanying editorial says that the risk is small and the main concern is defining the proper " normal " thyroid-stimulating hormone (TSH) level in this age group.Using Ontario's prescription-benefit database, researchers conducted a case-control study among more than 200,000 adults (mean age, 82) who were using thyroxine any time over a 5-year period. Current and recent thyroxine use (within the past 6 months) were both associated with an increased risk for fracture, compared with remote use (discontinued more than 6 months previously). Both high and medium cumulative doses showed increased fracture risk over low doses.Editorialists criticize the lack of TSH data — a limitation the authors acknowledge — and point out that " elderly people need relatively low thyroxine doses, so serum TSH should be regularly monitored and a suppressed TSH should be avoided in such patients. " BMJ article (Free)BMJ editorial (Subscription required)_______________________________________________ NB: They didn't test natural, desiccated thyroid in this study - results are based only upon studies with T4.