Yang Ruifei, Yao Liang, Fang Yuan, Sun Jing, Guo Tiankang, Yang Kehu, Tian Limin
Department of Endocrinology, The Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, Gansu, People's Republic of China.
Institution of Clinical Research and Evidence Based Medicine, The Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, Gansu, People's Republic of China.
J Bone Miner Metab. 2018 Mar;36(2):209-220. doi: 10.1007/s00774-017-0828-5. Epub 2017 Mar 29.
Our aim was to assess the risk of fractures or low bone mineral density (BMD) associated with subclinical thyroid dysfunction among cohorts. We systematically searched Medline (via PubMed), EMBASE, Cochrane Library, Web of Science, CENTRAL and SinoMed up to 31 July 2016 to identify cohort studies which have analyzed associations between subclinical thyroid dysfunction and fracture or BMD. A total of 19 population-based cohorts including 79,368 participants with relationships between subclinical thyroid dysfunction and fractures or BMD were identified as eligible for this meta-analysis. Subclinical hypothyroidism was associated with relative risks (RRs) of 1.34 (95% confidence interval [CI] 1.14, 1.58; I = 32%) for hip fracture, 1.27 (95% CI 1.02, 1.58; I = 51.9%) for any location of fracture, and 1.25 (95% CI 1.04, 1.50) for forearm fracture. Subclinical hyperthyroidism was associated with RRs of 1.71 (95% CI 1.06, 2.76; I = 0.0%) for spine fracture, 1.20 (95% CI 1.03, 1.39; I = 0.0%) for non-spine fracture, 1.44 (95% CI 1.21, 1.71; I = 0.0%) for hip fracture, and 1.38 (95% CI 1.21, 1.58; I = 0.0%) for any location of fracture. Subgroup analysis was conducted according to whether thyroid/anti-thyroid drug users were excluded or not and the results were similar. The change in BMD at the hip (weighted mean difference [WMD] = -0.060, 95% CI -0.116, -0.004; I = 0.0%) and femoral neck (WMD = -0.046, 95% CI -0.077, -0.015; I = 0.0%) was significantly decreased in the subclinical hyperthyroidism group compared with the euthyroidism groups in females. We failed to find any associations between the change in BMD and subclinical hypothyroidism. The overall quality of evidence was low in all outcomes. Subclinical hyperthyroidism and subclinical hypothyroidism were associated with an increased risk of fractures. Although subclinical hyperthyroidism was related to reduced BMD, no evidence could prove a definite association between subclinical hypothyroidism and the risk of low BMD.
我们的目的是评估队列研究中与亚临床甲状腺功能障碍相关的骨折或低骨密度（BMD）风险。我们系统检索了截至2016年7月31日的Medline（通过PubMed）、EMBASE、Cochrane图书馆、科学网、CENTRAL和中国生物医学文献数据库，以识别分析亚临床甲状腺功能障碍与骨折或BMD之间关联的队列研究。共确定了19个基于人群的队列，包括79368名参与者，这些队列中亚临床甲状腺功能障碍与骨折或BMD之间的关系符合本荟萃分析的纳入标准。亚临床甲状腺功能减退与髋部骨折的相对风险（RRs）为1.34（95%置信区间[CI]1.14，1.58；I² = 32%），任何部位骨折的RRs为1.27（95%CI 1.02，1.58；I² = 51.9%），前臂骨折的RRs为1.25（95%CI 1.04，1.50）。亚临床甲状腺功能亢进与脊柱骨折的RRs为1.71（95%CI 1.06，2.76；I² = 0.0%），非脊柱骨折的RRs为1.20（95%CI 1.03，1.39；I² = 0.0%），髋部骨折的RRs为1.44（95%CI 1.21，1.71；I² = 0.0%），任何部位骨折的RRs为1.38（95%CI 1.21，1.58；I² = 0.0%）。根据是否排除甲状腺/抗甲状腺药物使用者进行了亚组分析，结果相似。与甲状腺功能正常组相比，亚临床甲状腺功能亢进组女性髋部（加权平均差[WMD] = -0.060，95%CI -0.116，-0.004；I² = 0.0%）和股骨颈（WMD = -0.046，95%CI -0.077，-0.015；I² = 0.0%）的骨密度变化显著降低。我们未发现骨密度变化与亚临床甲状腺功能减退之间存在任何关联。所有结局的总体证据质量较低。亚临床甲状腺功能亢进和亚临床甲状腺功能减退与骨折风险增加相关。虽然亚临床甲状腺功能亢进与骨密度降低有关，但没有证据能证明亚临床甲状腺功能减退与低骨密度风险之间存在明确关联。
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