Osteoporosis independent of traditional risk factors in hyperthyroid patients in a resource-limited setting: An observational study

Abstract

Hyperthyroidism accelerates bone turnover and increases the risk of secondary osteoporosis. However, evidence from sub-Saharan Africa remains scarce. This study assessed the prevalence and predictors of osteoporosis among hyperthyroid patients without traditional risk factors for bone loss at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. A cross-sectional study was conducted from April to July/ 2025 among adults aged 18 to 50 years with confirmed hyperthyroidism at at least 6 months of follow-up. Patients with traditional osteoporosis risk factors, such as menopause, glucocorticoid use, rheumatoid arthritis, smoking were excluded. Socio-demographic clinical and biochemical data were collected. Bone mineral density at lumbar spine, total hip and femoral neck was measured using dual-energy X-ray absorptiometry (DXA). Multivariable logistic regression was used to identify predictors of osteoporosis. Among 51 participants (88.2% female; mean age 38.5 ± 7.4 years), 19 (37.3%) had DXA-confirmed osteoporosis. The median Z-score for lumbar, left total hip and left femoral neck were -1.5, -0.7, and -0.5, respectively. Osteoporosis was more common among patients with uncontrolled hyperthyroidism (66.7%) when compared to those with euthyroid (30.6%) and hypothyroid (33.3%) states. However, no independent predictors were identified on multivariable analysis. More than a third of hyperthyroid patients without traditional risk factors had low bone mineral density, underscoring the skeletal impact of thyroid hormone excess. Routine DXA screening and early intervention should be considered even for younger hyperthyroid patients in resource-limited settings.