Hypothyroidism, Hyperthyroidism and Bone Health

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Learn how your thyroid can affect your bone health, with this guide to thyroid disorders.

Disclaimer: If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Well Guide contain information from peer-reviewed research, medical societies and governmental agencies; however, these articles are not a substitute for professional medical advice, diagnosis, or treatment.

The thyroid is a small, butterfly-shaped gland in your neck that serves an essential role in regulating metabolism and secreting hormones. These hormones can affect nearly every organ system of your body. Having high levels of thyroid hormone can increase bone turnover and contribute to bone loss. Osteoporosis, a condition marked by significant bone loss that affects millions of women, can become a concerning side effect when thyroid hormones are overactive.

This article will explore the connection between thyroid disorders such as hyperthyroidism and hypothyroidism and osteoporosis. By unraveling key factors contributing to bone density loss, we aim to empower you with knowledge that will help you and your doctor make proactive health decisions about your bone health.

What is the thyroid?

The thyroid is a small gland in the neck that sits just below the larynx (your Adam’s apple). The thyroid produces hormones that are essential for skeletal development and regulating bone maintenance in adults (Williams, 2018). More specifically, it produces thyroid hormone and calcitonin, which contribute to the regulation of metabolism, growth, and electrolytes such as calcium (Allen, 2023).

What is the link between thyroid disease and osteoporosis?

Many disease processes can involve the thyroid gland, and bone loss can occur from thyroid gland dysfunction. Thyroid hormones stimulate bone turnover in adults by increasing bone breakdown. Excess thyroid hormone production (hyperthyroidism) can lead to lower bone mineral density and increased fracture risk (Williams, 2018). 

Hyperthyroidism can occur from the body producing too much thyroid hormone or from a person with an underactive thyroid being on too much thyroid medication (levothyroxine). In certain conditions such as thyroid cancer, the goal of treatment may be hyperthyroidism. It is important to have your bone density monitored to ensure, if there is significant bone loss, that bone treatment is considered.

Furthermore, the thyroid gland can be involved in inflammatory and autoimmune conditions, as well as certain cancers (Allen, 2023). Thyroid disorders, such as hypothyroidism and hyperthyroidism, in particular, impact the delicate equilibrium necessary for maintaining strong bones, often leading to an increased risk of osteoporosis in the setting of hyperthyroidism.

Hyperthyroidism and osteoporosis

Hyperthyroidism refers to an overactive thyroid state. In this condition, bone turnover is accelerated, which disrupts the normal bone remodeling process (Williams, 2018). Excessive thyroid hormone levels can lead to increased bone resorption, where bone is broken down at a faster rate than it can be replaced. This heightened turnover weakens bone structure and elevates the susceptibility to breaking bones. 

According to the Journal of Endocrinological Investigation, this makes hyperthyroidism “an established cause of high bone turnover with accelerated bone loss leading to osteoporosis and increased fracture susceptibility” (Williams, 2018). Understanding the impact of hyperthyroidism on bone health is crucial for implementing preventive measures and early interventions.

Hypothyroidism and osteoporosis

Hypothyroidism is a condition in which the thyroid is underactive. This leads to low thyroid hormone levels. An underactive thyroid results in low bone turnover with decreased bone formation. Hypothyroidism does not appear to cause osteoporosis however it is clear that too high a dose of thyroid hormone replacement can lead to overt hyperthyroidism and bone loss and fractures.

How to reduce your risk of osteoporosis

In summary, an overactive thyroid (hyperthyroidism) is associated with lower bone mineral density and an elevated risk of fractures. Because of this, there is a need for heightened awareness and proactive management to prevent bone loss and osteoporosis. 

If you have thyroid issues, here are some things you can do to protect your bone health:

  • Monitor thyroid levels: Make sure your thyroid levels remain in the normal range. Regular monitoring of your thyroid levels can help you avoid the risk of bone loss from hyperthyroidism. These blood tests can be measured routinely in your doctor's office, and do not require fasting. 
  • Monitor calcium and vitamin D levels: It’s important to also have your calcium level and Vitamin D level checked to ensure these are in a good range. Both are important for healthy and strong bones. If you are not getting enough calcium in your daily diet, your doctor may recommend you take supplements. 
  • See your doctors: Schedule your regular appointments with your primary care physician and endocrinologist to make sure thyroid function and bone health are both being monitored and treated appropriately. 
  • Exercise: Participate in an exercise program like Wellen’s that focuses on exercises to improve bone health, such as weight-bearing, resistance, posture and balance exercises. 
  • Ask questions: Never hesitate to ask questions, and make sure you are taking proactive steps to build and maintain bone strength so you can prevent fractures and stay active as you age. 
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  1. Williams GR, Bassett JHD. Thyroid diseases and bone health. J Endocrinol Invest. 2018 Jan;41(1):99-109. doi: 10.1007/s40618-017-0753-4. Epub 2017 Aug 29. PMID: 28853052; PMCID: PMC5754375.
  2. Allen E, Fingeret A. Anatomy, Head and Neck, Thyroid. StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470452/. Accessed on December 20, 2023.

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