Garin Margaret C, Arnold Alice M, Lee Jennifer S, Robbins John, Cappola Anne R
Division of Endocrinology, Diabetes, and Metabolism (M.C.G., A.R.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Biostatistics (A.M.A.), University of Washington, Seattle, Washington 98155; Division of Endocrinology, Gerontology, and Metabolism (J.S.L.), Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System (J.S.L.), Palo Alto, California 94305; and Division of General Medicine (J.R.), University of California, Davis, Sacramento, California 95817.
J Clin Endocrinol Metab. 2014 Aug;99(8):2657-64. doi: 10.1210/jc.2014-1051. Epub 2014 May 30.
Subclinical thyroid dysfunction is common in the elderly, yet its relationship with hip fracture and bone mineral density (BMD) is unclear.
We examined the association between endogenous subclinical hyper- and hypothyroidism and hip fracture and BMD in older adults.
A total of 4936 US individuals 65 years old or older enrolled in the Cardiovascular Health Study and not taking thyroid preparations were included. Analyses of incident hip fracture were performed by thyroid status, over a median follow-up of 12 years. A cross-sectional analysis of thyroid status and BMD was performed in a subset of 1317 participants who had dual-energy x-ray absorptiometry scans. Models were adjusted for risk factors and stratified by sex.
No association was found between subclinical hypothyroidism and incident hip fracture compared with euthyroidism, when assessed at a single time point or persisting at two time points, in either women [hazard ratio (HR) 0.91, 95% confidence interval (CI) 0.69-1.20 for a single and HR 0.79, 95% CI 0.52-1.21 for two time points] or men (HR 1.27, 95% CI 0.82-1.95 for a single and HR 1.09, 95% CI 0.57-2.10 for two time points). Likewise, no association was found between subclinical hyperthyroidism and incident hip fracture in either sex (HR 1.11, 95% CI 0.55-2.25 in women and HR 1.78, 95% CI 0.56-5.66 in men). No association was found between subclinical thyroid dysfunction and BMD at the lumbar spine, total hip, or femoral neck sites.
Our data suggest no association between subclinical hypothyroidism or subclinical hyperthyroidism and hip fracture risk or BMD in older men and women. Additional data are needed to improve the precision of estimates for subclinical hyperthyroidism and in men.
亚临床甲状腺功能障碍在老年人中很常见，但其与髋部骨折和骨密度（BMD）的关系尚不清楚。
我们研究了老年人内源性亚临床甲状腺功能亢进和减退与髋部骨折及骨密度之间的关联。
共有4936名65岁及以上未服用甲状腺制剂且参加心血管健康研究的美国个体纳入研究。在中位随访12年期间，按甲状腺状态对髋部骨折事件进行分析。对1317名接受双能X线吸收测定扫描的参与者进行甲状腺状态和骨密度的横断面分析。模型针对危险因素进行了调整，并按性别分层。
在女性中，无论是在单个时间点评估还是在两个时间点持续存在，亚临床甲状腺功能减退与正常甲状腺功能相比，均未发现与髋部骨折事件存在关联[单个时间点的风险比（HR）为0.91，95%置信区间（CI）为0.69 - 1.20；两个时间点的HR为0.79，95% CI为0.52 - 1.21]；在男性中也是如此[单个时间点的HR为1.27，95% CI为0.82 - 1.95；两个时间点的HR为1.09，95% CI为0.57 - 2.10]。同样，在任何性别中，亚临床甲状腺功能亢进与髋部骨折事件均未发现关联（女性的HR为1.11，95% CI为0.55 - 2.25；男性的HR为1.78，95% CI为0.56 - 5.66）。在腰椎、全髋或股骨颈部位，未发现亚临床甲状腺功能障碍与骨密度之间存在关联。
我们的数据表明，在老年男性和女性中，亚临床甲状腺功能减退或亚临床甲状腺功能亢进与髋部骨折风险或骨密度之间无关联。需要更多数据来提高对亚临床甲状腺功能亢进估计的准确性以及针对男性的研究。
