Segna D, Bauer D C, Feller M, Schneider C, Fink H A, Aubert C E, Collet T-H, da Costa B R, Fischer K, Peeters R P, Cappola A R, Blum M R, van Dorland H A, Robbins J, Naylor K, Eastell R, Uitterlinden A G, Rivadeneira Ramirez F, Gogakos A, Gussekloo J, Williams G R, Schwartz A, Cauley J A, Aujesky D A, Bischoff-Ferrari H A, Rodondi N
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Departments of Medicine and Epidemiology & Biostatistics, University of California, San Francisco, CA, USA.
J Intern Med. 2018 Jan;283(1):56-72. doi: 10.1111/joim.12688. Epub 2017 Oct 16.
Subclinical hyperthyroidism (SHyper) has been associated with increased risk of hip and other fractures, but the linking mechanisms remain unclear.
To investigate the association between subclinical thyroid dysfunction and bone loss.
Individual participant data analysis was performed after a systematic literature search in MEDLINE/EMBASE (1946-2016). Two reviewers independently screened and selected prospective cohorts providing baseline thyroid status and serial bone mineral density (BMD) measurements. We classified thyroid status as euthyroidism (thyroid-stimulating hormone [TSH] 0.45-4.49 mIU/L), SHyper (TSH < 0.45 mIU/L) and subclinical hypothyroidism (SHypo, TSH ≥ 4.50-19.99 mIU/L) both with normal free thyroxine levels. Our primary outcome was annualized percentage BMD change (%ΔBMD) from serial dual X-ray absorptiometry scans of the femoral neck, total hip and lumbar spine, obtained from multivariable regression in a random-effects two-step approach.
Amongst 5458 individuals (median age 72 years, 49.1% women) from six prospective cohorts, 451 (8.3%) had SHypo and 284 (5.2%) had SHyper. During 36 569 person-years of follow-up, those with SHyper had a greater annual bone loss at the femoral neck versus euthyroidism: %ΔBMD = -0.18 (95% CI: -0.34, -0.02; I = 0%), with a nonstatistically significant pattern at the total hip: %ΔBMD = -0.14 (95% CI: -0.38, 0.10; I = 53%), but not at the lumbar spine: %ΔBMD = 0.03 (95% CI: -0.30, 0.36; I = 25%); especially participants with TSH < 0.10 mIU/L showed an increased bone loss in the femoral neck (%Δ BMD = -0.59; [95% CI: -0.99, -0.19]) and total hip region (%ΔBMD = -0.46 [95% CI: -1.05, -0.13]). In contrast, SHypo was not associated with bone loss at any site.
Amongst adults, SHyper was associated with increased femoral neck bone loss, potentially contributing to the increased fracture risk.
亚临床甲状腺功能亢进（SHyper）与髋部及其他骨折风险增加相关，但相关机制仍不清楚。
研究亚临床甲状腺功能障碍与骨质流失之间的关联。
在MEDLINE/EMBASE（1946 - 2016年）中进行系统文献检索后，进行个体参与者数据分析。两名审阅者独立筛选并选择提供基线甲状腺状态和连续骨密度（BMD）测量值的前瞻性队列。我们将甲状腺状态分为甲状腺功能正常（促甲状腺激素[TSH] 0.45 - 4.49 mIU/L）、亚临床甲状腺功能亢进（SHyper，TSH < 0.45 mIU/L）和亚临床甲状腺功能减退（SHypo，TSH≥4.50 - 19.99 mIU/L），且游离甲状腺素水平均正常。我们的主要结局是通过随机效应两步法进行多变量回归，从股骨颈、全髋和腰椎的连续双能X线吸收测定扫描中得出的骨密度年变化百分比（%ΔBMD）。
在来自六个前瞻性队列的5458名个体（中位年龄72岁，49.1%为女性）中，451名（8.3%）患有SHypo，284名（5.2%）患有SHyper。在36569人年的随访期间，与甲状腺功能正常者相比，SHyper患者股骨颈的年骨质流失更大：%ΔBMD = -0.18（95%CI：-0.34，-0.02；I = 0%），在全髋处有非统计学显著趋势：%ΔBMD = -0.14（95%CI：-0.38，0.10；I = 53%），但在腰椎处无差异：%ΔBMD = 0.03（95%CI：-0.30，0.36；I = 25%）；尤其是TSH < 0.10 mIU/L的参与者在股骨颈（%Δ BMD = -0.59；[95%CI：-0.99，-0.19]）和全髋区域（%ΔBMD = -0.46 [95%CI：-1.05，-0.13]）的骨质流失增加。相比之下，SHypo与任何部位的骨质流失均无关联。
在成年人中，SHyper与股骨颈骨质流失增加相关，这可能导致骨折风险增加。
