Physical activity and reduced risk of fracture in thyroid cancer patients after thyroidectomy - a nationwide cohort study

Jinyoung Kim; Kyungdo Han; Jin-Hyung Jung; Jeonghoon Ha; Chaiho Jeong; Jun-Young Heu; Se-Won Lee; Jeongmin Lee; Yejee Lim; Mee Kyoung Kim; Hyuk-Sang Kwon; Ki-Ho Song; Ki-Hyun Baek

doi:10.3389/fendo.2023.1173781

Physical activity and reduced risk of fracture in thyroid cancer patients after thyroidectomy - a nationwide cohort study

Front Endocrinol (Lausanne). 2023 Jul 20:14:1173781. doi: 10.3389/fendo.2023.1173781. eCollection 2023.

Authors

Jinyoung Kim¹, Kyungdo Han², Jin-Hyung Jung², Jeonghoon Ha³, Chaiho Jeong⁴, Jun-Young Heu⁵, Se-Won Lee⁵, Jeongmin Lee⁶, Yejee Lim⁷, Mee Kyoung Kim¹, Hyuk-Sang Kwon¹, Ki-Ho Song¹, Ki-Hyun Baek¹

Affiliations

¹ Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, ;Republic of Korea.
² Department of Statistics and Actuarial Science, Soongsil University, Seoul, ;Republic of Korea.
³ Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, ;Republic of Korea.
⁴ Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, ;Republic of Korea.
⁵ Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, ;Republic of Korea.
⁶ Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, ;Republic of Korea.
⁷ Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

Abstract

Objectives: Levothyroxine suppressive therapy following thyroidectomy for thyroid cancer patients is considered as a risk factor for osteoporosis and fragility fractures. We evaluated the association of regular exercise and exercise habit change with fracture risk in adults older than 40 years who underwent thyroidectomy for thyroid cancer.

Methods: We enrolled the patients who underwent thyroidectomy for thyroid cancer older than 40 years between 2010 and 2016 from the Korean National Health Insurance Service data, and they were followed through 2019. Based on the questionnaire of health examination within 2 years before and after surgery, whether regular exercise once a week was evaluated. The reference group for the statistical analysis was the continuing lack of physical activity group that did not exercise before or after surgery. For fractures newly diagnosed during the follow-up period, univariate and multivariate Cox regression analyses were performed for risk evaluation.

Results: We evaluated 74,774 subjects, of whom 2,924 (3.9%) experienced any fractures during a median follow-up of 4.5 years. Compared with the group consistently lack of physical activity, the group that exercised before and after surgery showed a significant decrease in the risk of any fracture, vertebral fracture, and hip fracture: adjusted hazard ratio 0.848 (95% Confidence Interval 0.771-0.932), 0.703 (0.591-0.836), and 0.405 (0.224-0.732), respectively. For vertebral fracture, a significant reduction in fracture risk was confirmed even in patients who started their regular exercise after surgery: adjusted hazard ratio 0.779 (0.648-0.936). The risk reduction for vertebral fractures upon the initiation of exercise was found to be significant in the high-risk groups of patients: women and total thyroidectomy patients.

Conclusion: We suggest that maintaining or starting regular exercise after surgery may help prevent fractures in thyroid cancer patients older than 40 years who have undergone thyroidectomy.

Keywords: cancer survivorship; fracture; physical activity; prevention and control; thyroid cancer.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cohort Studies
Exercise
Female
Hip Fractures* / prevention & control
Humans
Spinal Fractures*
Thyroid Neoplasms* / epidemiology
Thyroid Neoplasms* / etiology
Thyroid Neoplasms* / surgery
Thyroidectomy / adverse effects

Grants and funding

This research was supported by a grant from Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea.