Division of Endocrinology and Metabolism, University of California, San Francisco, San Francisco, CA, USA.
J Bone Miner Res. 2013 Mar;28(3):472-9. doi: 10.1002/jbmr.1774.
Excess thyroid hormone is associated with increased bone loss and fracture risk in older women, but few data exist for men. We sought to determine if thyroid function is independently associated with bone loss and fracture risk in older men. Data were analyzed from the Osteoporotic Fractures in Men (MrOS) study, a cohort of community-dwelling U.S. men aged 65 years and older. Using a case-cohort design, fasting baseline serum archived at -80°C was assayed for thyroid-stimulating hormone (thyrotropin) (TSH) and free thyroxine (FT4) in 397 men with confirmed nonspine fracture, including 157 hip fractures, and 1420 randomly selected men without fracture. TSH and FT4 were analyzed as continuous variables and as thyroid function categories (subclinical hyperthyroid, euthyroid, and subclinical hypothyroid). Hip dual-energy X-ray absorptiometry (DXA) (Hologic QDR4500) was measured at baseline and after a mean follow-up of 4.6 years. Incident nonspine fractures were centrally adjudicated. Bone loss was evaluated with multivariate regression methods and fractures risk was evaluated using hazard models that accounted for the case-cohort sampling, adjusted for age, clinic-site, body mass index (BMI), race, physical activity, corticosteroid use, smoking, alcohol intake, and thyroid medication use. In fully adjusted analyses, TSH was not associated with risk of nonspine fracture (relative hazard [RH] 0.92 per SD decrease in TSH; 95% confidence interval [CI], 0.74-1.14), but was significantly associated with risk of hip fracture (RH 1.31; 95% CI, 1.01-1.71), which persisted among normal range TSH values (RH 1.21; 95% CI, 1.00-1.47). There was no association between TSH or FT4 and bone loss, and fracture risk did not differ significantly by thyroid function category. We conclude that although neither TSH nor FT4 are associated with bone loss, lower serum TSH may be associated with an increased risk of hip fractures in older men.
甲状腺激素过多与老年女性的骨丢失和骨折风险增加有关，但男性的数据很少。我们试图确定甲状腺功能是否与老年男性的骨丢失和骨折风险独立相关。该数据来自男性骨质疏松症研究（MrOS），这是一项美国社区居住的年龄在 65 岁及以上的男性队列研究。使用病例-队列设计，在 397 名确诊为非脊柱骨折（包括 157 例髋部骨折和 1420 名随机选择的无骨折男性）的男性中，使用存档的空腹基线血清检测促甲状腺激素（TSH）和游离甲状腺素（FT4），这些血清在 -80°C 下保存。TSH 和 FT4 被分析为连续变量和甲状腺功能类别（亚临床甲亢、甲状腺功能正常和亚临床甲减）。基线时测量髋部双能 X 射线吸收法（DXA）（Hologic QDR4500），并在平均 4.6 年的随访后进行测量。中心裁定了新发非脊柱骨折。使用多元回归方法评估骨丢失，使用风险模型评估骨折风险，该模型考虑了病例-队列抽样，调整了年龄、诊所地点、体重指数（BMI）、种族、体力活动、皮质类固醇使用、吸烟、饮酒和甲状腺药物使用。在完全调整的分析中，TSH 与非脊柱骨折风险无关（TSH 每降低 1 个标准差的相对危险度 [RH] 为 0.92；95%置信区间 [CI]，0.74-1.14），但与髋部骨折风险显著相关（RH 为 1.31；95% CI，1.01-1.71），在 TSH 正常范围内仍存在这种相关性（RH 为 1.21；95% CI，1.00-1.47）。TSH 或 FT4 与骨丢失之间没有关联，并且不同甲状腺功能类别的骨折风险没有显著差异。我们的结论是，尽管 TSH 和 FT4 均与骨丢失无关，但血清 TSH 水平较低可能与老年男性髋部骨折风险增加有关。
