I read with interest Wartofsky's1 editorial "Levothyroxine Therapy and Osteoporosis: An End to the Controversy?" Although he nicely summarizes the numerous and often contradictory studies of the relationship between thyroid hormone use and bone mass, it was disturbing that he did not point out that the most important issue in this controversy is the relationship between thyroid hormone use and fractures.
To my knowledge, only one large prospective study has examined the relationship between thyroid disease and fractures.2,3 In the Study of Osteoporotic Fractures, it was found that postmenopausal women with a history of hyperthyroidism had an 80% increase in the risk of subsequent hip fracture and that thyroid hormone use itself was associated with a 60% increase in risk (although the increased risk of fracture was no longer statistically significant after adjustment for previous hyperthyroidism). These analyses did not include measurements of thyroid function, but such studies
Bauer DC. Thyroid Hormone Use and Fractures. Arch Intern Med. 1996;156(3):341-342. doi:10.1001/archinte.1996.00440030149021