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T. J. Allain
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A. M. McGregor
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Introduction

There is immense current interest in the effects of thyroid hormones on bone. This is largely due to concern that patients on thyroxine replacement therapy are at increased risk of developing osteoporosis; this concern follows a number of reports describing reduced bone mineral density in this group of patients. The issue is, however, uncertain and the purpose of this review is (i) to summarize what is known about the effects of thyroid hormones on bone at both an experimental and clinical level and (ii) to try to reach a greater understanding of the problem and its implications for patient management.

Bone biology

Bone remodelling requires the tightly coupled actions of osteoclasts and osteoblasts. A normal bone remodelling cycle takes approximately 200 days. Each cycle begins with activation of cells which become osteoclasts and start resorbing bone. This phase lasts for about 50 days and is terminated

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Russell T Turner Skeletal Biology Laboratory, Center for Healthy Aging Research, Department of Neuroscience, Biostatistics, Department of Physiological Sciences, Department of Large Animal Clinical Sciences, Maine Medical Center Research Institute, School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon 97331, USA
Skeletal Biology Laboratory, Center for Healthy Aging Research, Department of Neuroscience, Biostatistics, Department of Physiological Sciences, Department of Large Animal Clinical Sciences, Maine Medical Center Research Institute, School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon 97331, USA

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Michael Dube Skeletal Biology Laboratory, Center for Healthy Aging Research, Department of Neuroscience, Biostatistics, Department of Physiological Sciences, Department of Large Animal Clinical Sciences, Maine Medical Center Research Institute, School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon 97331, USA

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Adam J Branscum Skeletal Biology Laboratory, Center for Healthy Aging Research, Department of Neuroscience, Biostatistics, Department of Physiological Sciences, Department of Large Animal Clinical Sciences, Maine Medical Center Research Institute, School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon 97331, USA

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Carmen P Wong Skeletal Biology Laboratory, Center for Healthy Aging Research, Department of Neuroscience, Biostatistics, Department of Physiological Sciences, Department of Large Animal Clinical Sciences, Maine Medical Center Research Institute, School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon 97331, USA

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Dawn A Olson Skeletal Biology Laboratory, Center for Healthy Aging Research, Department of Neuroscience, Biostatistics, Department of Physiological Sciences, Department of Large Animal Clinical Sciences, Maine Medical Center Research Institute, School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon 97331, USA

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Xiaoying Zhong Skeletal Biology Laboratory, Center for Healthy Aging Research, Department of Neuroscience, Biostatistics, Department of Physiological Sciences, Department of Large Animal Clinical Sciences, Maine Medical Center Research Institute, School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon 97331, USA

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Mercedes F Kweh Skeletal Biology Laboratory, Center for Healthy Aging Research, Department of Neuroscience, Biostatistics, Department of Physiological Sciences, Department of Large Animal Clinical Sciences, Maine Medical Center Research Institute, School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon 97331, USA

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Iske V Larkin Skeletal Biology Laboratory, Center for Healthy Aging Research, Department of Neuroscience, Biostatistics, Department of Physiological Sciences, Department of Large Animal Clinical Sciences, Maine Medical Center Research Institute, School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon 97331, USA

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Thomas J Wronski Skeletal Biology Laboratory, Center for Healthy Aging Research, Department of Neuroscience, Biostatistics, Department of Physiological Sciences, Department of Large Animal Clinical Sciences, Maine Medical Center Research Institute, School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon 97331, USA

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Clifford J Rosen Skeletal Biology Laboratory, Center for Healthy Aging Research, Department of Neuroscience, Biostatistics, Department of Physiological Sciences, Department of Large Animal Clinical Sciences, Maine Medical Center Research Institute, School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon 97331, USA

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Satya P Kalra Skeletal Biology Laboratory, Center for Healthy Aging Research, Department of Neuroscience, Biostatistics, Department of Physiological Sciences, Department of Large Animal Clinical Sciences, Maine Medical Center Research Institute, School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon 97331, USA

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Urszula T Iwaniec Skeletal Biology Laboratory, Center for Healthy Aging Research, Department of Neuroscience, Biostatistics, Department of Physiological Sciences, Department of Large Animal Clinical Sciences, Maine Medical Center Research Institute, School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon 97331, USA
Skeletal Biology Laboratory, Center for Healthy Aging Research, Department of Neuroscience, Biostatistics, Department of Physiological Sciences, Department of Large Animal Clinical Sciences, Maine Medical Center Research Institute, School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon 97331, USA

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this approach can induce weight loss and/or maintain lower body weight in aging rodents with normal circulating levels of the hormone ( Shapiro et al . 2008 ). In humans, calorie restriction-induced weight loss is often associated with bone loss

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Sonu Khanka Division of Endocrinology, CSIR-Central Drug Research Institute, Lucknow, India
Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India

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Charul Somani Department of Chemistry, Mohanlal Sukhadia University, Udaipur-Rajasthan, India

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Kriti Sharma Division of Endocrinology, CSIR-Central Drug Research Institute, Lucknow, India
Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India

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Shivani Sharma Division of Endocrinology, CSIR-Central Drug Research Institute, Lucknow, India
Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India

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Akhilesh Kumar Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
Sophisticated Analytical Instrument Facility & Research, Division, CSIR-Central Drug Research Institute, Lucknow, India

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Naibedya Chattopadhyay Division of Endocrinology, CSIR-Central Drug Research Institute, Lucknow, India
Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India

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Sanjeev K Kanojiya Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
Sophisticated Analytical Instrument Facility & Research, Division, CSIR-Central Drug Research Institute, Lucknow, India

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Dinesh Kumar Yadav Department of Chemistry, Mohanlal Sukhadia University, Udaipur-Rajasthan, India

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Divya Singh Division of Endocrinology, CSIR-Central Drug Research Institute, Lucknow, India
Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India

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Introduction Osteoporosis is a major medical and socioeconomic problem among elderly people, particularly affecting postmenopausal women. Impaired bone mass, strength and deterioration of bone microarchitecture are consequences associated with

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J Jeyabalan
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M Shah
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B Viollet Department of Veterinary Basic Sciences, INSERM, CNRS, Université Paris Decartes, INSERM, Department of Endocrinology, Royal Veterinary College, Royal College Street, London NW1 0TU, UK
Department of Veterinary Basic Sciences, INSERM, CNRS, Université Paris Decartes, INSERM, Department of Endocrinology, Royal Veterinary College, Royal College Street, London NW1 0TU, UK
Department of Veterinary Basic Sciences, INSERM, CNRS, Université Paris Decartes, INSERM, Department of Endocrinology, Royal Veterinary College, Royal College Street, London NW1 0TU, UK

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J P Roux Department of Veterinary Basic Sciences, INSERM, CNRS, Université Paris Decartes, INSERM, Department of Endocrinology, Royal Veterinary College, Royal College Street, London NW1 0TU, UK

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P Chavassieux Department of Veterinary Basic Sciences, INSERM, CNRS, Université Paris Decartes, INSERM, Department of Endocrinology, Royal Veterinary College, Royal College Street, London NW1 0TU, UK

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M Korbonits Department of Veterinary Basic Sciences, INSERM, CNRS, Université Paris Decartes, INSERM, Department of Endocrinology, Royal Veterinary College, Royal College Street, London NW1 0TU, UK

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C Chenu
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anabolic pathways that consume ATP. In the last few years, several in vitro and in vivo studies have established that the AMPK signalling pathway could also play a role in bone physiology ( Kanazawa et al . 2008 , 2009 , Kasai et al . 2009 , Lee

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Andrei S Chagin Pediatric Endocrinology Laboratory, Department of Women's and Children's Health, Karolinska Institutet, Stockholm SE-17176, Sweden

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Elham Karimian Pediatric Endocrinology Laboratory, Department of Women's and Children's Health, Karolinska Institutet, Stockholm SE-17176, Sweden

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Katja Sundström Pediatric Endocrinology Laboratory, Department of Women's and Children's Health, Karolinska Institutet, Stockholm SE-17176, Sweden

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Emma Eriksson Pediatric Endocrinology Laboratory, Department of Women's and Children's Health, Karolinska Institutet, Stockholm SE-17176, Sweden

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Lars Sävendahl Pediatric Endocrinology Laboratory, Department of Women's and Children's Health, Karolinska Institutet, Stockholm SE-17176, Sweden

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Introduction Longitudinal bone growth occurs at the growth plate by a process called endochondral ossification where a continuously formed cartilage template is substituted by newly formed bone tissue ( Kronenberg 2003 , Chagin & Savendahl 2007

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Lucie E Bourne Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK

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Caroline PD Wheeler-Jones Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK

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Isabel R Orriss Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK

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calcification. In journal articles, the terms ‘calcification’ and ‘mineralisation’ are used interchangeably. Nonetheless, mineralisation is most often used in the context of bone and refers to the process of laying down minerals within an extracellular matrix

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Marina Komrakova
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Stephan Sehmisch
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Mohammad Tezval
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Ulrich Schmelz Department of Trauma Surgery and Reconstructive Surgery, Subdivision of General Hygiene and Environmental Health, Department of Organic and Biomolecular Chemistry, University of Goettingen, Robert-Koch Street 40, 37075 Goettingen, Germany

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Holm Frauendorf Department of Trauma Surgery and Reconstructive Surgery, Subdivision of General Hygiene and Environmental Health, Department of Organic and Biomolecular Chemistry, University of Goettingen, Robert-Koch Street 40, 37075 Goettingen, Germany

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Thomas Grueger
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Thomas Wessling
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Carolin Klein
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Miriam Birth
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Klaus M Stuermer
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Ewa K Stuermer
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Introduction Osteoporosis is a disease characterized by a decrease in bone mass and deterioration in bone structure with a consequent increase in bone fragility and risk of fracture. The bone loss is most related to estrogen deficiency and age- and

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Rakefet Pando Felsenstein Medical Research Center, Sackler Faculty of Medicine, Robert H. Smith Faculty of Agriculture, Faculty of Agricultural, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Petach Tikva, Israel
Felsenstein Medical Research Center, Sackler Faculty of Medicine, Robert H. Smith Faculty of Agriculture, Faculty of Agricultural, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Petach Tikva, Israel

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Majdi Masarwi Felsenstein Medical Research Center, Sackler Faculty of Medicine, Robert H. Smith Faculty of Agriculture, Faculty of Agricultural, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Petach Tikva, Israel
Felsenstein Medical Research Center, Sackler Faculty of Medicine, Robert H. Smith Faculty of Agriculture, Faculty of Agricultural, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Petach Tikva, Israel

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Biana Shtaif Felsenstein Medical Research Center, Sackler Faculty of Medicine, Robert H. Smith Faculty of Agriculture, Faculty of Agricultural, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Petach Tikva, Israel
Felsenstein Medical Research Center, Sackler Faculty of Medicine, Robert H. Smith Faculty of Agriculture, Faculty of Agricultural, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Petach Tikva, Israel

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Anna Idelevich Felsenstein Medical Research Center, Sackler Faculty of Medicine, Robert H. Smith Faculty of Agriculture, Faculty of Agricultural, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Petach Tikva, Israel

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Efrat Monsonego-Ornan Felsenstein Medical Research Center, Sackler Faculty of Medicine, Robert H. Smith Faculty of Agriculture, Faculty of Agricultural, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Petach Tikva, Israel

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Ron Shahar Felsenstein Medical Research Center, Sackler Faculty of Medicine, Robert H. Smith Faculty of Agriculture, Faculty of Agricultural, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Petach Tikva, Israel

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Moshe Phillip Felsenstein Medical Research Center, Sackler Faculty of Medicine, Robert H. Smith Faculty of Agriculture, Faculty of Agricultural, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Petach Tikva, Israel
Felsenstein Medical Research Center, Sackler Faculty of Medicine, Robert H. Smith Faculty of Agriculture, Faculty of Agricultural, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Petach Tikva, Israel
Felsenstein Medical Research Center, Sackler Faculty of Medicine, Robert H. Smith Faculty of Agriculture, Faculty of Agricultural, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Petach Tikva, Israel

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Galia Gat-Yablonski Felsenstein Medical Research Center, Sackler Faculty of Medicine, Robert H. Smith Faculty of Agriculture, Faculty of Agricultural, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Petach Tikva, Israel
Felsenstein Medical Research Center, Sackler Faculty of Medicine, Robert H. Smith Faculty of Agriculture, Faculty of Agricultural, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Petach Tikva, Israel
Felsenstein Medical Research Center, Sackler Faculty of Medicine, Robert H. Smith Faculty of Agriculture, Faculty of Agricultural, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Petach Tikva, Israel

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. 2002 ). The skeleton undergoes rapid structural adaptations to the demands of the growing body, manifested by elongation and bone modeling, together with changes in the bone mineral composition, cortical and trabecular architecture, and altered

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Eugenie Macfarlane Bone Research Program, ANZAC Research Institute, The University of Sydney, Australia

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Hong Zhou Bone Research Program, ANZAC Research Institute, The University of Sydney, Australia

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Markus J Seibel Bone Research Program, ANZAC Research Institute, The University of Sydney, Australia
Department of Endocrinology and Metabolism, Concord Repatriation General Hospital, Sydney, Australia

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-body physiology, highlighting the role of bone as an endocrine organ ( Pierce et al. 2019 , 2022 ). Additionally, the GR has distinct actions in bone loss, fracture healing, and arthritis, which are dependent on sex, ageing, the disease context, cell type, and

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Terhi J Heino Pediatric Endocrinology Unit, Department of Woman and Child Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Q2:08, SE-171 76 Stockholm, Sweden

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Andrei S Chagin Pediatric Endocrinology Unit, Department of Woman and Child Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Q2:08, SE-171 76 Stockholm, Sweden

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Lars Sävendahl Pediatric Endocrinology Unit, Department of Woman and Child Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Q2:08, SE-171 76 Stockholm, Sweden

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Introduction Estrogen (17β-estradiol) is an important regulator of bone metabolism, which is illustrated by the low bone mass phenotype in a man carrying a mutation in estrogen receptor-α (ERα; Smith et al . 1994 ) and in individuals with a

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