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October 21, 1988

Decreased Bone Density and Thyroxine

Author Affiliations

Mayo Clinic Rochester, Minn

Mayo Clinic Rochester, Minn

JAMA. 1988;260(15):2219. doi:10.1001/jama.1988.03410150067028

To the Editor.—  I write to comment on the article by Paul et al1 reporting decreased femoral bone mineral density in women taking thyroxine in replacement or suppressive doses.The study by Paul et al is interesting and provocative, but is neither definitive nor consonant with other findings. For example, for thyroxine to cause decreased cortical bone density in the femur but no change in the more labile, preponderantly trabecular spinal bone mineral density seems unlikely. One must be uneasy about the inclusion of patients who had earlier suffered from Graves' disease, because of its known effect on bone density. With respect to those patients who had Hashimoto's thyroiditis, some of them might have had accompanying thyrotoxicosis. There are other elements in the data suggesting that this could have been a case-selection phenomenon rather than a specific effect of thyroxine; for example, Paul et al found no differences between