Clin Osteol 2003; 8(2): 33-43

Thyroid hormones and boneArticles

L. Baqi, J. Payer, Z. Killinger

Thyroid hormones have a crucial role in development of bones during fetal period, bone modulation in childhood and in remodelling cycles in adult hood. Sufficient exposure to thyroid hormones is necessary for normal skeletal development. Thyroid hormone is necessary for the recruitment and maturation of bone cells. Deficienty of thyroid hormones production in utero and in the neonate retards growth and delays skeletal maturation. The presence of thyroid hormone increases bone remodelling. Excess thyroid hormone alters the hormonal regulation of calcium metabolism and can con­ tribute to bone loss. Hyperthyroidism accelerates bone turnover and shortens the normal bone remodelling cycle. Thyroid hormone seems to be mo­ re affecting to cortical bone than to trabecular bone. The aim of our article is to give an idea about the developments of this issue and on the basis of results of available literature data to compare the characters of morphological and morphokinet to evaluate the risk of fractures in different thyroid gland disorders.

Keywords: thyroid hormones, thyroxine, hyperthyroidism, bone mineral density, osteoporosis.

Published: December 11, 2003  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Baqi L, Payer J, Killinger Z. Thyroid hormones and bone. Osteologický bulletin. 2003;8(2):33-43.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Sawin CT, Geller A, Hershman JM, et al. The hormone in older persons. JAMA 1989;261:2653-5. Go to original source...
    2. Lips P. Epidemiolog Am J Med 1997;103:3-8. Go to original source...
    3. von Recklinghausen FD. Die Fibrose oder deformierende Ostitis, die Osteoma zie und die osteoplastische Carzinose in ihren gegenseitigen Beziehungen. In: Festschrift Rudolph Virchow. Berlin: Reiner, 1891:20-89.
    4. Ross DS, Neer RM, Ridgway EC, et al. Subclinical hyperthyroidism and reduced bone density as a possible result of prolonged suppression of the pituitary-thy id axis with L-thyroxine. Am J Med 1987;82:1167-70. Go to original source...
    5. Dieguez C, Jordan V, Harris P, Foord S et al. Growth hormone responses to growth hormone-releasing factor 1-29 in euthyroid, hypothyroid, and hyperthy­ roid rats. J Endocrinol 1986;109:53-56. Go to original source...
    6. Thorngren KG, Hansson LI. Effect of thyroxine and growth hormone on longitu­ dinal bone growth in the hypophysectomized rat. Acta Endocrinol 1973;74: 24 40. Go to original source...
    7. Harada Y, Okada Y, Hikita T et al. Comparison of growth acceleration o tary dwarfs treated with anabolic steroid and thyroid hormone with normal growth spurt. Acta Endocrinol 1973;74:237-249. Go to original source...
    8. Valcavi R, Dieguez C, Preece M, Taylor A, Portioli I, Scanlon MF. Effect o roxine replacement therapy on plasma insuline-like growth factor I levels and growth hormone responses to growth hormone releasing factor in hypothyroid patients. Clin Endocrinol 1998;27:85-90. Go to original source...
    9. Schmid C, Schlapfer I, Futo E, Waldvogel M et al. Triiodothyronine (T3) stimu­ lates insulin-like growth factor (IGF)-1 and IGF binding protein (IGFB duction by rat osteoblasts in vitro. Acta Endocrinol 1992;126:467-473. Go to original source...
    10. Payer J, Killinger Z. Osteoporóza pri endokrinných ochoreniach. In: Spustová Osteoporóza. Bratislava: SAP, 1998:99-104.
    11. Baxter JD, Bondy PK. Hypercalcemia of thyrotoxicosis. Ann Intern Med 1966;65:429-442. Go to original source...
    12. Fallon MD, Perry HMI, Bergfeld M, Droke D, Avioli LV, Teitelbaum SL. Exo­ genous hyperthyroidism with osteoporosis. Arch Intern Med 1983;143:442-444. Go to original source...
    13. Jastrup B, Mosekilde L, Melsen F et al. Serum levels of vitamin D metabolism and bone remodeling in hyperthyroidism. Metab Clin Exp 1982;31:126-132. Go to original source...
    14. Haldimann B, Kaptein EM, Singer FR, Nicoloff JT et al. Intestinal calci sorption in patients with hyperthyroidism. J Clin Endocrinol Metab 1980;51: 995-997. Go to original source...
    15. Bouillon R, De Moor P. Parathyroid function in p hyroidism. J Clin Endocrinol Metab 1974;38:999-1004. Go to original source...
    16. Bouillon R, Muls E, De Moor P. Influence of thyroid function on the serum centration of 1,25-dihydroxyvitamin D3. J Clin Endocrinol Metab 1980;51: 793-797. Go to original source...
    17. Lekkerkerker JFF, Doorenbos H. The influence of thyroid hormone on calcium absorption from 1973;73:672-680.
    18. Yamamoto M, Markatos A, Seedor JG, Masarachia P et al. The effects ofthe no bisphosphonate alendronate on thyroid hormone-induced osteopenia in rats. Calcif Tissue Ing 1993;53:278-282. Go to original source...
    19. Mosekilde L, Eriksen EF, Charles P. Effects of thyroid hormone on bone and neral metabolism. Endocrinol Metab Clin North Am 1990;19:35-63. Go to original source...
    20. DeMenis E, DeRin G, Roiter I, Legovini P, Foscolo G, Conte N. Bone turnover in overt and subclinical hyperthyroidism due to autonomous thyroid hormone. Horm Res 1992;37:217-220. Go to original source...
    21. Kawaguchi H, Pilbeam CC, Woodiel FN, Raisz LG. Comparison of the effects of 3,5,3-triiodothyroacetic acid and triiodothyronine on bone resorption in cu fetal rat long bones and neonatal mouse calvariae. J Bone Miner Res 1994;9: 247-253. Go to original source...
    22. Britto JM, Fenton AJ, Holloway WR, Nicholson GC. Osteoblasts mediate thyro­ id hormo 169-176.
    23. Solomon BL, Wartofsky L, Burman KD. Prevalence of sal women with thyreoid disease. Thyroid 1993;3:17-23. Go to original source...
    24. Akalin A, Colak O, Alatas O, Efe B. Bone remodelling markers and s kines in patients with hyperthyroidism. Clin Endocrinol 2002;57:125-9. Go to original source...
    25. Miura M, Tanaka K, Komatsu Y, Suda M et al. A Novel Interaction betwe roid Hormones and 1,25(OH)(2) D(3) in Osteoclast Formation. Biochem Biop­ hys Res Commun 2002;291:987-94. Go to original source...
    26. Ongphiphadhanakul B, Jenis LG, Braverman LE, Alex S, Stein GS, Lian JB, Ba­ ran DT. Etidronate inhibits the thyroid hormone-induced bone loss in rats asses­ sed by bone mineral density and messenger ribonuclei acid and osteoclast function. Endocrinology 1993;133:2502-2207. Go to original source...
    27. Jodar E, Martinez-Diaz-Guerra G, Azriel S, Hawkins F. Bone mineral density male patients with L-thyroxine suppressive therapy and Graves disease. Calcif Tissue Int 2001;69:84-7. Go to original source...
    28. Harvey RD, McHardy KC, Ried IW et al. Measurement of bone collagen degra­ dation in hyperthyroidism and during thyroxine replacemetn therapy using pyridinum cros 1189-1194. Go to original source...
    29. Krakerauer JC, Kleerekoper M. Borderline low serum thyrotropin level is co lated with increased fasting urinary hydroxyproline excretion. Arch Intern Med 1992;152:360-364. Go to original source...
    30. Garnero P, Vassy V, Bertholin A et al. Markers of bone turnover in hyperth dism and the effects of treatment. J Clin Endocrinol Metab 1994;78:955-959. Go to original source...
    31. Okawa M, Kushida K, Takahashi M, Ohishi T, Hoshino H, Suzuki M, Ogihara H, Ishigaki G, Inoue T. Bone turnover and cortical bone mineral density in the distal radius in patients with hyperthyroidism being treated with antithyroid drugs for various periods of time. Clin Endocrinol 1999;50:171-176. Go to original source...
    32. Sabuncu T, Aksoy N, Arikan E et al. Early changes in parameters of bone ral metabolism during therapy for hyperthyroidism and hypothyroidism. Endocr Res 2001;27:203-13. Go to original source...
    33. Brixen K, Nielsen HK, Eriksen EF, Charles P, Mosekilde L. Efficacy of wheat germ lectin-precipitated alkaline phosphatase in serum as an estimator of bone mineralization rate: Comparison to serum total alk bone gla-protein. Calcif Tissue Ing 1989;44:93-98. Go to original source...
    34. Obermayer-Pietsch BM, Fruhauf GE, Chararas K et al. Association of the min D receptor genotype BB with low bone density in hyperthyroidism. J Bone Miner Res 2000;15:1950-5. Go to original source...
    35. Ban Y, Ban Y, Taniyama M, Katagiri T. Vitamin D receptor initiation codon lymorphism in Japanese patients with Graves' disease. Thyroid 2000;10:475-80. Go to original source...
    36. Leger J, Tourrel C, Ruiz JC, Czernichow P, Garabedian M. Vitamin D receptor genotype and bone mineral density in Caucasian childre hyroidism. J Pediatr Endocrinol Metab 2000;13:599-603. Go to original source...
    37. U.S. Preventive Services Task Force. Screening for thyroid disease. In: Guide Clinical Preventive Services. 2d ed. Baltimore: Wiliams Wilkins, 1996:209-18.
    38. Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 1995;332:767-73. Go to original source...
    39. Wejda B, Hintze G, Katschinski B, Olbricht T, Benker G. Hip fractures and the thyroid: a case - control study. J Intern Med 1995;237:241-7. Go to original source...
    40. Vestergaard P, Mosekilde L. Fractures in patients with hyperthyroi pothyroidism: a nationwide follow-up study in 16,249 patients. Thyroid 2002;12:411-9. Go to original source...
    41. Diamond T, Vine J, Smart R, Butler P. Thyrotoxic bone disease in women: tentially reversible disorder. Ann Intern 1994;120:8-11. Go to original source...
    42. Grant DJ, McMurdo ME, Mole PA, Paterson CR. Is previous hyperthyroidism still a risk factor f (Oxf) 1995;43:339-45.
    43. Campos-Pastor MM, Munoz-Torres M, Escobar-Jimenez F et al. Bone mass in fe­ males with diffe ner 1993;21:1-8.
    44. Duncan WE, Chang A, Solomon B, Wartofsky L. Influence of clinical characte­ ristics and parameters associated with thyroid hormone therapy on the bone neral density of women treated with thyroid hormone. Thyroid 1994;4:183-90. Go to original source...
    45. Adlin EV, Maurer AH, Marks AD, Channick BJ. Bone mineral densi menopausal women treated with L-thyroxine. Am J Med 1991;90:360-6. Go to original source...
    46. Lee MS, Kim SY, Lee MC et al. Negative correlation between the change in bo­ ne mineral density and serum osteocalcin in patients with hyperthyroidism. J C Endocrinol Metab 1990;70:766-70. Go to original source...
    47. Ben-Shlomo A, Hagag P, Evans S, Weiss M. Early postmenopausal bone loss in hyperthyroidism. Maturitas 2001;39:19-27. Go to original source...
    48. Langdahl BL, Loft AG, Eriksen EF, Mosekilde L, Charles P. Bone mass, bone turnover, body composition, and calcium homeostasis in former hyperthyroid pa­ tients treated by combined medical therapy. Thyroid 1996;6:161-8. Go to original source...
    49. Langdahl BL, Loft AG, Eriksen EF, Mosekilde L, Charles P. Bonne mass, bone turnover, calcium homeostasis, and body composition in surgically and radioio­ dine-treated former hyperthyroid patients. Thyroid 1996;6:169-75.
    50. Isaia GC, Roggia C, Gola D et al. Bone turnover in hyperthyroidism befor and ter thyreostatic management. J Endocrinol Invest 2000;23:727-31. Go to original source...
    51. Krolner B, Jorgensen JV, Nielsen SP. Spinal bone mineral content in myxoedema and thyrotoxicosis. Effects of thyroid hormone(s) and antithyroid treatment. Clin Endocrinol(Oxf) 1983;18:439^6. Go to original source...
    52. Rosen CJ, Adler RA Longitudinal changes in lumbar bone density among thyro­ toxic patients after attainment of euthyroidism. J Clin Endocrinol Metab 1992;75: 1531-4. Go to original source...
    53. Franklyn JA, Betteridge J, Holder R, Sheppard MC. Effect of estrogen replace­ ment therapy upon bone mineral density in thyroxine - treated postmenopausal women with a past history of thyrotoxicosis. Thyroid 1995;5:359-63. Go to original source...
    54. Greenspan SL, Greenspan FS. The effect of thyroid hormone on skeletal i ty. An Intern Med 1999;130:750-758. Go to original source...
    55. Singer PA, Cooper DS, Daniels GH, Ladenson PW, Greenspan FS, Levy EG et al. Treatment guidelines for patients with thyroid nodules and well-diff thyroid cancer. American Thyroid Association. Arch Intern Med 1996; 156: 2165-72. Go to original source...
    56. Klee GG, Hay ID. Role of thyrotropin measurements i gement of thyroid disease. Clin Lab Med 1993;13:673-82. Go to original source...
    57. Burmeister LA, Goumaz MO, Mariash C et al. Levothyroxine dose requirements for thyrotropin suppression in the tr Clin Endocrinol Metab 1992;75:344-50. Go to original source...
    58. Ross DS. Subclinical thyrotoxicosis. In: Werner SC, Ingbar SH, Braverman Utiger RD, eds. Werner and Ingbar. The Thyroid: A Fundamental and Clinical Text. 7 th ed. Philadelphia: Lippincott-Raven, 1996:1016-20.
    59. Florkowski CM, Brownlie BE, Elliot JR, Ayling EM, Turner JG. Bone mineral density in patients receiving ma. N Z Med J 1993;106:443 4.
    60. Muller CG, Bayley TA, Harrison JE, Tsang R. Possible limited bone loss with suppressive 1995;5:81-7.
    61. Franklyn JA, Betteridge J, Daykin J, Holder R, Oates GD, Parle JV et term thyroxine treatment and bone mineral density. Lancet 1992;340:9-13. Go to original source...
    62. Giannini S, Nobile M, Sartori L, Binotto P et al. Bone density and mineral tabolism in thyroidectomized patients treated with long term L-thyroxine. Clin Sci (Colch) 1994;87:593-7. Go to original source...
    63. Lehmke J, Bogner U, Felsenberg D, Peters H, Schleusener H. Determination of bone mineral density by quantitative computed tomography and single photon absorptiometry in subclinical hyperthyroidism: a risk of early osteopaenia in post-menopausal women. Clin Endocrinol (Oxf) 1992;36:511-7. Go to original source...
    64. Marcocci C, Golia F, Bruno-Bossio G, Vignali E, Pinchera A Carefully monito­ red levothyroxine suppressive therapy is not associated nopausal women. J Clin Endocrinol Metab 1994;78:818-23. Go to original source...
    65. Garton M, Reid I, Loveridge N, Robins S, Murchison L, Beckett G et al. B mineral density and metabolism in premenopausal women taking L-thyroxine re­ placement therapy. Clin Endocrinol (Oxf) 1994;41:747-55. Go to original source...
    66. Gorres G, Kaim A, Otte A, Gotze M, Muller-Brand J. Bone mineral density in patients receiving suppressive doses of thyroxine for differentiated thyroid c noma. Eur J Nucl Med 1996;23:690-2. Go to original source...
    67. De Rosa G, Testa A, Maussier ML, Calla C, Astazi P, Albanese C. A slightly suppressive dose of L-thyroxine does not affect bone turnover and bone mineral density in pre- and postmenopausal women with nontoxic goitre. Horm Metab Res 1995;27:503-7. Go to original source...
    68. Baldini M, Gallazzi M, Orsatti A et al. Treatment of benign nodular goitre w mildly suppressive doses of L-thyroxine: effects on bone mineral density and on nodule size. J Intern Med 2002;251:407-14. Go to original source...
    69. Diamond T, Nery L, Hales I. A therapeutic dilemma: suppressive doses of thy­ roxine significantly reduce bone mineral measurements in both premenopausal and postmenopausal women with thyroid carcinoma. J Clin Endocrinol Metab 1990;72:1184-8. Go to original source...
    70. Taelman P, Kaufman JM, Janssens X, Vandecauter H, Vermeulen A Reduced fo­ rearm bone mineral content and biochemical evidence of increased bone turno­ ver in women with euthyroid goitre treated with thyroid hormone. Clin Endocri­ nol (Oxf) 1990;33:107-17. Go to original source...
    71. Mudde AH, Reijnders FJ, Kruseman AC. Peripheral bone density in women with untreated multinodular goitre. Clin Endocrinol (Oxf) 1992;37:35-9. Go to original source...
    72. Foldes J, Tarjan G, Szathmari M, Varga F, Krasznai I, Horvath C. Bone mineral density in patients with endogenous subclinical hyperthyroidism: is this th status a risk factor for osteoporosis. Clin Endocrinol (Oxf) 1993;39:521-7. Go to original source...
    73. Paul TL, Kerrigan J, Kelly AM, Braverman LE, Baran DT. Long-term L-thyroxine therapy is associated w men. JAMA 1988;259:3137-H. Go to original source...
    74. Rosen HN, Moses AC, Garber J, Ross DS, Lee SL, Ferguson L et al. Randomi­ zed trial of pamidronate in patients with thyroid cancer: bone density is not re­ duced by suppressive doses of thyroxine, but is incre pamidronate. J Clin Endocrinol Metab 1998;83:2324-30. Go to original source...
    75. Pioli G, Jbdrazzoni M, Palummeri E, Sianesi M, Del Frate R, Vescovi PP et Longitudinal study of bone loss after thyroidectomy and suppressive thyroxine therapy in premeno-pausal women. Acta Endocrinol (Copenh) 1992;126:238^-2. Go to original source...
    76. McDermott MT, Perloff JJ, Kidd GS. A longitudinal assessment of bone loss in women with levothyroxine-suppres Calcif Tissue Int 1995;56:521-5. Go to original source...
    77. Lopez Alvarez MB, Hawkins F, Rigopoulou D et al. The risk factors and mine­ ral densi 112:85-9.
    78. Sijanovic S, Karner I. Bone loss in premenopausal women on long-ter ressive therapy with thyroid hormone. Mediscape Womens Health 2001;6:3.
    79. Bauer DC, Ettinger B, Nevitt MC et al. Risk for Fracture in Wom rum Levels of Thyroid-Stimulating Hormone. Ann Intern Med 2001;134: 561-568. Go to original source...
    80. Uzzan B, Campos J, Cucherat M, Nony P, Boissel JP, Perret GY. Effects on ne mass of long term treatment with thyroid hormones: a meta-analysis. J Clin Endocrinol Metab 1996;81:4278-89. Go to original source...
    81. Faber J, Galloe AM. Changes in bone mass during prolonged subclinical hypert­ hyroidism 130:350-6.
    82. Zelmanovitz F, Genro S, Gross JL. Suppressive therapy with levothyroxine for solitary thyroid nodules: a double-blind controlled clinical study and cumul meta-analyses. J Clin Endocrinol Metab 1998;83:3881-5. Go to original source...
    83. Schneider DL, Barrett-Connor EL, Morton DJ. Thyroid hormone use and bone mineral density in elderly women. Effects of estrogen. JAMA 1994;271:1245-9. Go to original source...
    84. Kung AW, Lorentz T, Tam SC. Thyroxine suppressive therapy decreases bone mineral density in post-menopausal women. Clin Endocrinol (Oxf) 1993;39: 535 40. Go to original source...
    85. Stall GM, Harris S, Sokol LJ, Dawson-Hughes B. Accelerated bone loss in hypo roid patients overtreated with L-thyroxine. Ann Intern Med 1990;113: 265-9. Go to original source...
    86. Grant DJ, McMurdo ME, Mole PA et al. Suppressed TSH levels secondary to thy­ roxine replacement therapy are not associated with osteoporosis. Clin Endocrinol (Oxf) 1993;39:529-33. Go to original source...
    87. Ribot C, Tremollieres F, Pouilles JM, Louvet JP. Bone mineral density and t roid hormone therapy. Clin Endocrinol (Oxf) 1990;33:143-53. Go to original source...
    88. Kung AW, Yeung SS. Prevention of bone loss induced by thyroxine suppressive therapy in postmenopausal women : the effect of calcium and calcitonin. J Clin Endocrinol Metab 1996;81:1232-6. Go to original source...
    89. Stepan JJ, Limanova Z. Biochemical assessment ofbone loss in patients on l term thyroid homone treatment. Bone Miner 1992;17:377-388. Go to original source...
    90. Department of Health and Human Services, Health Care Financing Administra­ tion. Medicare program; Medicare coverage of and payments for bone mass measurements-HCFA Interim final rule with comment period. Fed Regist 1998;63: 34321.
    91. Physician's Guide to Prevention and Treatment of Osteoporosis. Washington, D.C.: National Osteoporosis Foundation, 1998:1-38.
    92. Campos SP, Sandberg DE et al. Outcome of lower L-thyrox of congenital hypothyroidism. Clin Pediatr 1995; 34:514-20. Go to original source...
    93. Ehrlich 34:521-522.
    94. Van Vliet G. Treatment of congenital hypothyroidism. Lancet
    95. Van Vliet G. Neonatal hypothyroidism. Thyroid 1999;9:79-84. Go to original source...
    96. Singer PA, Cooper DS, Levy EG, Ladenson PW et al. Treatment guidelines patients with hyperthyroidism and hypothyroidism. Standards of Care Commit­ tee, American Thyroid Association. JAMA 1995;273:808-12. Go to original source...
    97. Vestergaard P, Weeke J, Hoeck HC et al. Fr pathic hypothyroidism. Thyroid 2000;10:335-40. Go to original source...
    98. Ross DS. Bone density is not reduced during the short-term administration of vothyroxine to postmenopausal women with subclinical hypothyroidism: a ran­ domized, prospective study. Am J Med 1993;95:385-8. Go to original source...
    99. Greenspan SL, Greenspan FS, Resnick NM, Block JE et al. Skeletal integrity in premenopausal and postmenopausal women receiving long-term L-thyroxine the­ rapy. Am J Med 1991;91:5-14. Go to original source...
    100. Kung AW, Pun KK. Bone mineral density in premenopausal women rece long-term physiological doses of levothyroxine. JAMA 1991;265:2688-91. Go to original source...
    101. Saggese G, Bertelloni S, Baroncelli GI, Costa S, Ceccarelli C. Bone mineral sity in adolescent females treated with L-thyroxine: a longitudinal study. Eur J Pediatr 1996;155:452-7. Go to original source...
    102. Franklyn J. Betteridge J, Holder R, Daykin J et al. Bone mineral density in t roxine treated females with or without a previous history of thyrotoxicosis. Clin Endocrinol (Oxf) 1994;41:425-32. Go to original source...
    103. Hawkins F, Rigopoulou D, Papapietro K, Lopez MB. Spinal bone mass after long-term treatment with L-thyroxine in postmenopausal women with thyroid cancer and chronic lymphocytic thyroiditis. Calcif Tissue Int 1994;54:16-9. Go to original source...
    104. Werner SC. Hypothyroidism, treatment, In: Werner SC, Ingbar SH, eds. The Thy­ roid: A Fundamental and Clinical Text. 4th ed. Hagerstown, M.D, Harper Row, 1978:965-70.
    105. Werner SC. Nontoxic goiter and thyroid cancer: modalities of medical therapy. In: Werner SC, Ingbar SH, eds. The Thyroid: A Fundamental and Clinical Text. 4th ed. Hagerstown, M.D.: Harper Row, 1978:525-7.
    106. Mandel SJ, Brent GA, Larsen PR. Levothyroxine therapy in patients with thyro­ id disease. Ann Intern Med 1993;119:492-5O2. Go to original source...
    107. Rosen HN, Moses AC, Gundberg C, Kung VT et al. Therapy with parenteral pamidronate prevents thyroid hormone-induced bone turnover in humans. J Clin Endocrinol Metab 1993;77:664-9. Go to original source...

    Return to the content


    Clinical Osteology

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.