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Thyroid Hormone Use and Fractures-Reply

Leonard Wartofsky, MD
Arch Intern Med. 1996;156(3):342-344. doi:10.1001/archinte.1996.00440030149022.
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I am grateful for Bauer's comments and am now aware of his group's study,1 which noted an increased risk of subsequent hip fracture in postmenopausal women with a history of hyperthyroidism. Although their important paper had not yet been published when my editorial was submitted to the Archives in 1994, their work would not have changed the thrust of my editorial. Their observed increased risk of 60% more hip fractures with a history of thyroid hormone use translates to an approximate relative risk of only 1.66, and it is not surprising that the risk becomes insignificant when corrected for prior hyperthyroidism. Endocrinologists have been aware for some time that a history of thyrotoxicosis may increase the risk of osteopenia and potential subsequent fracture2,3 and that this risk is compounded in the estrogen-deficient postmenopausal woman. The increased risk of fracture may be related to the duration and severity of


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