Lee Jennifer S, Buzková Petra, Fink Howard A, Vu Joseph, Carbone Laura, Chen Zhao, Cauley Jane, Bauer Doug C, Cappola Anne R, Robbins John
Department of Internal Medicine, University of California, Davis, Sacramento, 95817, USA.
Arch Intern Med. 2010 Nov 22;170(21):1876-83. doi: 10.1001/archinternmed.2010.424.
Subclinical thyroid dysfunction is common in older adults and affects bone metabolism, but its effects on fracture risk have not been reported. We sought to determine prospectively whether older men and women with subclinical hyperthyroidism or hypothyroidism have an increased risk of hip fracture.
Prospective cohort of 3567 US community-dwelling adults, 65 years or older, with biochemically defined subclinical thyroid dysfunction or euthyroidism was enrolled from June 10, 1989, through May 30, 1990, and followed up through 2004. Main outcome measures included incidence and hazard ratios (HRs), with 95% confidence intervals (CIs), of confirmed incident hip fractures for groups with subclinical hypothyroidism, subclinical hyperthyroidism, and euthyroidism as defined at baseline.
During 39 952 person-years (median follow-up, 13 years), hip fracture incidence (per 1000 men-years) was 13.65 in men with subclinical hyperthyroidism (n = 29) and 10.27 in men with subclinical hypothyroidism (n = 184), both greater than 5.0 in men with euthyroidism (n = 1159). Men with subclinical hypothyroidism had a multivariable-adjusted HR of 2.31 (95% CI, 1.25-4.27); those with subclinical hyperthyroidism, 3.27 (0.99-11.30). After excluding those with baseline use of thyroid-altering medications, men with endogenous subclinical hyperthyroidism had a higher HR of 4.91 (95% CI, 1.13-21.27), as did men with endogenous subclinical hypothyroidism (2.45, 1.27-4.73). Hip fracture incidence (per 1000 women-years) was 8.93 in women with subclinical hypothyroidism (n = 359) and 10.90 in women with subclinical hyperthyroidism (n = 142) compared with 10.18 in women with euthyroidism (n = 1694). No clear association between subclinical dysfunction and fracture was observed in women.
Older men with subclinical hyperthyroidism or hypothyroidism are at increased risk for hip fracture. Whether treatment of the subclinical syndrome reduces this risk is unknown.
亚临床甲状腺功能障碍在老年人中很常见，且会影响骨代谢，但尚未有关于其对骨折风险影响的报道。我们旨在前瞻性地确定患有亚临床甲状腺功能亢进或减退的老年男性和女性髋部骨折风险是否增加。
1989年6月10日至1990年5月30日，招募了3567名年龄在65岁及以上、居住在美国社区、经生化指标定义为亚临床甲状腺功能障碍或甲状腺功能正常的成年人组成前瞻性队列，并随访至2004年。主要结局指标包括亚临床甲状腺功能减退组、亚临床甲状腺功能亢进组和基线时定义的甲状腺功能正常组确诊的新发髋部骨折的发病率和风险比（HR）及95%置信区间（CI）。
在39952人年（中位随访时间为13年）期间，亚临床甲状腺功能亢进男性（n = 29）的髋部骨折发病率（每1000人年）为13.65，亚临床甲状腺功能减退男性（n = 184）为10.27，均高于甲状腺功能正常男性（n = 1159）的5.0。亚临床甲状腺功能减退男性的多变量调整HR为2.31（95%CI，1.25 - 4.27）；亚临床甲状腺功能亢进男性为3.27（0.99 - 11.30）。排除基线时使用甲状腺改变药物的患者后，内源性亚临床甲状腺功能亢进男性的HR更高，为4.91（95%CI，1.
