Melton L J, Ardila E, Crowson C S, O'Fallon W M, Khosla S
Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Bone. 2000 Nov;27(5):695-700. doi: 10.1016/s8756-3282(00)00379-3.
Hip fracture risk has been associated with hyperthyroidism and thyroidectomy in men and with hyperthyroidism in women, but the influence of thyroidectomy on fracture risk in women has not been adequately addressed. The 630 Rochester, MN women who underwent thyroidectomy in 1950-1974 were followed subsequently for 12,804 person-years (retrospective cohort study) during which 601 fractures were observed. Relative to incidence rates in the community, there was no increase in overall fracture risk (standardized incidence ratio [SIR] 0.9; 95% confidence interval [CI] 0.8-1.00). No increase was seen in limb fractures generally or in distal forearm fractures specifically (SIR 1.1, 95% CI 0.8-1.4). There was a modest but statistically significant increase in the risk of hip fractures following thyroidectomy (SIR 1.3, 95% CI 1.01-1.8), but much greater increases were apparent in the risk of subsequent fractures of the ribs, spine, and pelvis. There was almost a threefold increase in vertebral fractures (SIR 2.8, 95% CI 2.3-3.3), but the excess was mostly observed long after the original operation and may be attributable to ascertainment bias. Fracture risk was associated with advancing age and with the presence of one or more of the diseases that have been associated with secondary osteoporosis but not with a history of hyperthyroidism, extent of thyroid surgery, or subsequent use of thyroid replacement therapy. Thus, with the exception of some fractures of the axial skeleton, which might have been more completely diagnosed among affected women, there was no increase in fracture risk among women following thyroidectomy performed mainly for adenoma or goiter.
髋部骨折风险在男性中与甲状腺功能亢进和甲状腺切除术有关，在女性中与甲状腺功能亢进有关，但甲状腺切除术对女性骨折风险的影响尚未得到充分研究。对1950年至1974年间在明尼苏达州罗切斯特市接受甲状腺切除术的630名女性进行了随访，随访时间为12804人年（回顾性队列研究），在此期间观察到601例骨折。与社区发病率相比，总体骨折风险没有增加（标准化发病率[SIR]为0.9；95%置信区间[CI]为0.8 - 1.00）。一般肢体骨折或特别是远端前臂骨折的风险没有增加（SIR为1.1，95%CI为0.8 - 1.4）。甲状腺切除术后髋部骨折风险有适度但具有统计学意义的增加（SIR为1.3，95%CI为1.01 - 1.8），但肋骨、脊柱和骨盆随后骨折的风险增加更为明显。椎体骨折几乎增加了两倍（SIR为2.8，95%CI为2.3 - 3.3），但这种增加大多在原手术很久之后才观察到，可能归因于确诊偏倚。骨折风险与年龄增长以及一种或多种与继发性骨质疏松相关的疾病有关，但与甲状腺功能亢进病史、甲状腺手术范围或随后使用甲状腺替代疗法无关。因此，除了一些可能在受影响女性中得到更全面诊断的轴向骨骼骨折外，主要因腺瘤或甲状腺肿进行甲状腺切除术后的女性骨折风险没有增加。
