Bone turnover markers and their associations with longitudinal changes in bone mineral density and trabecular bone score in children and adolescents with graves

Pattara Wiromrat; Ratikorn Chaisiwamongkol; Nantaporn Wongsurawat; Yutapong Raruenrom; Piyanan Suparattanagool; Ouyporn Panamonta; Chatlert Pongchaiyakul

doi:10.1530/endoabs.110.EP199

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Endocrine Abstracts (2025) 110 EP199 | DOI: 10.1530/endoabs.110.EP199

ECEESPE2025 ePoster Presentations Bone and Mineral Metabolism (142 abstracts)

Bone turnover markers and their associations with longitudinal changes in bone mineral density and trabecular bone score in children and adolescents with graves’ disease

Pattara Wiromrat ¹ , Ratikorn Chaisiwamongkol ¹ , Nantaporn Wongsurawat ² , Yutapong Raruenrom ² , Piyanan Suparattanagool ³ , Ouyporn Panamonta ¹ & Chatlert Pongchaiyakul ⁴

Author affiliations

¹Khon Kaen University, Pediatrics, Khon Kaen, Thailand; ²Khon Kaen University, Nuclear Medicine, Khon Kaen, Thailand; ³Khon Kaen University, Epidemiology, Khon Kaen, Thailand; ⁴Khon Kaen University, Internal Medicine, Khon Kaen, Thailand

JOINT263

Background: Adults with Graves’ disease (GD) exhibit reduced bone mineral density (BMD) and impaired trabecular bone microarchitecture, both of which typically improve with euthyroid status. However, data on these changes in adolescents are limited, and factors influencing them remain unclear.

Objectives: To evaluate bone turnover marker (BTM) concentrations, longitudinal changes in BMD and trabecular bone score (TBS), and factors associated with these changes in adolescents with GD.

Methods: We enrolled 42 adolescents with GD who had baseline data available for lumbar spine BMD (LSBMD) and BTM concentrations measured on the same date. BTM concentrations were converted to Z-scores. On the study date, follow-up LSBMD was measured. TBS, a measure of trabecular bone microarchitecture, was analyzed using iNsight™ software version 2.2. Annual percentage changes in LSBMD (%ΔLSBMD/y) and TBS (%Δ206;TBS/y) were calculated. Time-weighted (TW) concentrations of free T3 (FT3), free T4 (FT4), and TSH were determined over the follow-up period.

Results: Participants (74% female, mean age 13.5 ± 3.1 years, 90% Tanner stage ≥2, median [Q1–Q3] disease duration 1.3 [0.3–4.2] years, 45% receiving levothyroxine following radioiodine therapy [RAIT]) had a median follow-up duration of 2.2 (1.3–2.9) years. At baseline, four (10%) participants had a height-adjusted LSBMD Z-score ≤-2, and 2 (5%) had a TBS Z-score ≤-2. Participants with RAIT had longer disease duration (P<0.001), higher LSBMD Z-score (P = 0.002), and lower total procollagen type 1 N-terminal propeptide (P1NP) Z-score (P = 0.01) compared to those receiving antithyroid drug (ATD) therapy. %ΔLSBMD/y correlated positively with baseline FT3 (P = 0.011), TW FT3 (P<0.001), P1NP Z-score (P = 0.001), and osteocalcin Z-score (P = 0.011), and negatively with disease duration (P<0.001), RAIT (P<0.001), baseline TSH (P<0.001) and TW TSH (P = 0.037). %ΔTBS/y correlated positively with body mass index (BMI) Z-score (P = 0.022). Regression analysis revealed that P1NP Z-score was positively associated with %ΔLSBMD/y adjusting for age, sex, Tanner stage, BMI Z-score, disease duration, TW FT3, and TW TSH (P<0.001).

Conclusions: Adolescents with GD have a high prevalence of low LSBMD. Improvement in LSBMD during treatment is positively associated with FT3 and negatively with TSH concentrations over the follow-up period, while TBS improvement is associated only with BMI. Furthermore, P1NP independently predicts LSBMD improvement, suggesting its potential as a prognostic bone biomarker.