{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:28:31Z","timestamp":1791404911101,"version":"4.3.3"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"6","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2014,6]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>In this study, we aimed at evaluating the association between radiological vertebral fractures and levo-thyroxine (<jats:sc>l<\/jats:sc>-T<jats:sub>4<\/jats:sub>) replacement doses in adult patients with hypopituitarism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cross-sectional study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We studied 74 adult hypopituitary patients (males, 43; females, 31; mean age, 57 years; and range, 23\u201379) with central hypothyroidism treated with <jats:sc>l<\/jats:sc>-T<jats:sub>4<\/jats:sub> (median daily dose: 1.1\u200a\u03bcg\/kg). All patients also had severe GH deficiency (GHD) and 38 of them were replaced with recombinant GH. Vertebral fractures were assessed by a quantitative morphometric analysis performed on thoracic and lumbar spine lateral X-ray.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Radiological vertebral fractures were found in 23 patients (31.1%) in association with untreated GHD (<jats:italic>P<\/jats:italic>=0.02), higher serum free T<jats:sub>4<\/jats:sub> levels (<jats:italic>P<\/jats:italic>=0.03), a higher daily dose of <jats:sc>l<\/jats:sc>-T<jats:sub>4<\/jats:sub> (<jats:italic>P<\/jats:italic>=0.005), and a longer duration of hypopituitarism (<jats:italic>P<\/jats:italic>=0.05). When GHD was treated, the prevalence of vertebral fractures was more frequent (<jats:italic>P<\/jats:italic>=0.03) in patients receiving high <jats:sc>l<\/jats:sc>-T<jats:sub>4<\/jats:sub> doses (third tertile: &gt;1.35\u200a\u03bcg\/kg per day) as compared with patients who were treated with lower drug doses (first tertile: &lt;0.93\u200a\u03bcg\/kg per day). Such a difference was not observed in patients with untreated GHD who showed a higher prevalence of vertebral fractures regardless of <jats:sc>l<\/jats:sc>-T<jats:sub>4<\/jats:sub> daily doses. Multivariate analysis showed that untreated GHD (odds ratio: 4.27, 95% CI 1.27\u201314.33; <jats:italic>P<\/jats:italic>=0.01) and the daily dose of <jats:sc>l<\/jats:sc>-T<jats:sub>4<\/jats:sub> (odds ratio: 4.01, 95% CI 1.16\u201314.39; <jats:italic>P<\/jats:italic>=0.03) maintained a significant and independent association with vertebral fractures in patients with central hypothyroidism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our data suggest for the first time that a relative overtreatment with <jats:sc>l<\/jats:sc>-T<jats:sub>4<\/jats:sub> may influence the fracture risk in some patients with hypopituitarism.<\/jats:p><\/jats:sec>","DOI":"10.1530\/eje-14-0097","type":"journal-article","created":{"date-parts":[[2014,5,18]],"date-time":"2014-05-18T00:27:22Z","timestamp":1400372842000},"page":"893-899","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":46,"title":["Association between l-thyroxine treatment, GH deficiency, and radiological vertebral fractures in patients with adult-onset hypopituitarism"],"prefix":"10.1093","volume":"170","author":[{"given":"G","family":"Mazziotti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Mormando","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Cristiano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Bianchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"Porcelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Giampietro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F","family":"Maffezzoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V","family":"Serra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"De Marinis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Giustina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"issue":"1","key":"1_37604617","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.abb.2010.06.021","volume":"503","author":"Gogakos","year":"2010","journal-title":"Archives of Biochemistry and Biophysics","ISSN":"https:\/\/id.crossref.org\/issn\/1096-0384","issn-type":"print"},{"issue":"6","key":"2_17777905","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1089\/105072503322238854","volume":"13","author":"Vestergaard","year":"2003","journal-title":"Thyroid : official journal of the American Thyroid Association","ISSN":"https:\/\/id.crossref.org\/issn\/1050-7256","issn-type":"print"},{"issue":"7","key":"3_17435095","doi-asserted-by":"publisher","first-page":"561","DOI":"10.7326\/0003-4819-134-7-200104030-00009","volume":"134","author":"Bauer","year":"2001","journal-title":"Annals of Internal Medicine","ISSN":"https:\/\/id.crossref.org\/issn\/0003-4819","issn-type":"print"},{"issue":"3","key":"4_16896652","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1001\/archinte.162.3.338","volume":"162","author":"Sheppard","year":"2002","journal-title":"Archives of Internal Medicine","ISSN":"https:\/\/id.crossref.org\/issn\/0003-9926","issn-type":"print"},{"issue":"apr28_2","key":"5_39807040","doi-asserted-by":"publisher","first-page":"d2238","DOI":"10.1136\/bmj.d2238","volume":"342","year":"2011","journal-title":"BMJ","ISSN":"https:\/\/id.crossref.org\/issn\/0959-8138","issn-type":"print"},{"issue":"9","key":"6_46092365","doi-asserted-by":"publisher","first-page":"3562","DOI":"10.1210\/jc.2013-1315","volume":"98","year":"2013","journal-title":"Journal of Clinical Endocrinology &amp; 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