This scoping review evaluates the effects and changes of Graves' disease (GD) and its treatment on adult spine-related bone health.

GD is an autoimmune condition that leads to hyperthyroidism as well as systemic bone loss. Elevated thyroid hormone levels can increase osteoclastic activity, increase bone turnover and bone resorption, and lower bone mineral density (BMD). Although the euthyroid state has a protective role in spine and bone health, autoimmunity plays a pivotal role in long-term bone loss. 

Following Arksey and O’Malley's framework, we searched PubMed, Web of Science, Scopus, and Cochrane Library for interventional or observational studies until April 2024 using the relevant keywords. Two authors independently examined the results, and a third author resolved the disagreements. Data on key study characteristics such as publication year, study type, reported outcomes, and any patterns related to the effects of hyperthyroid changes on spinal health were emphasized.

Only 16 studies were included after the screening process, including eight cross-sectional, six longitudinal cohorts, one case-control, and one randomized controlled trial. Studies primarily on older men and postmenopausal women consistently showed lower spinal BMD in GD patients in hyperthyroid and euthyroid states, with a suggested role of elevated autoantibodies. Several studies reported structural bone degradation and an increased risk of fractures in patients with GD. Prospective studies showed partial improvement in spinal BMD with anti-thyroid therapy. Combining bisphosphonates with anti-thyroid therapy enhanced BMD recovery more than anti-thyroid therapy alone. 

GD affects bone health through excess thyroid hormone and autoimmunity, with persistent bone loss even after achieving an euthyroid state. High-risk groups such as postmenopausal women and older men require targeted strategies for both thyroid and skeletal health. Future research should focus on therapies targeting autoimmune processes to prevent possible fractures and osteoporosis.