Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia.
School of Medicine, University of Western Australia, Perth, WA, Australia.
Clin Endocrinol (Oxf). 2018 Jul;89(1):93-99. doi: 10.1111/cen.13615. Epub 2018 May 15.
Overt thyroid dysfunction is a risk factor for osteoporosis and fractures. Subclinical hyperthyroidism has also been associated with fracture. It remains unclear whether variation in thyroid hormones within the euthyroid range modulates bone health, particularly among older men. We assessed whether thyroid stimulating hormone (TSH) and free thyroxine (FT4) are associated with bone turnover markers (BTMs) and predict hip fracture risk in community-dwelling older men without known thyroid disease.
Prospective cohort study.
Four thousand two hundred forty-eight men aged 70-89 years.
Baseline blood samples were assayed for TSH, FT4, total osteocalcin (TOC), undercarboxylated osteocalcin (ucOC), N-terminal propeptide of type I collagen (P1NP) and collagen type I C-terminal cross-linked telopeptide (CTX). Incidence of hip fracture events was ascertained to 2012. Associations of TSH and FT4 with BTMs were analysed at baseline using Pearson correlation coefficients, and with incident hip fracture using Cox proportional hazards regression.
After excluding men with pre-existing thyroid or bone disease, there were 3, 338 men for analysis. Of these, 3, 117 were euthyroid, 135 had subclinical hypothyroidism, and 86 had subclinical hyperthyroidism. Men with subclinical thyroid disease were older, and those with subclinical hyperthyroidism had lower creatinine than the other groups. After multivariate analysis, there were no associations found between FT4, TSH or subclinical thyroid dysfunction and BTMs at baseline. Neither subclinical thyroid dysfunction, TSH nor FT4 were predictive of incident hip fracture in our study population.
In euthyroid older men, TSH and FT4 were not associated with BTMs or incident hip fracture. Our findings differ from those previously described in postmenopausal women.
显性甲状腺功能障碍是骨质疏松症和骨折的危险因素。亚临床甲状腺功能亢进也与骨折有关。目前尚不清楚甲状腺激素在正常范围内的变化是否会影响骨骼健康，尤其是在老年男性中。我们评估了促甲状腺激素（TSH）和游离甲状腺素（FT4）是否与骨转换标志物（BTMs）相关，并预测无已知甲状腺疾病的社区居住老年男性的髋部骨折风险。
前瞻性队列研究。
4248 名年龄在 70-89 岁的男性。
采集基线血样，检测 TSH、FT4、总骨钙素（TOC）、非羧化骨钙素（ucOC）、I 型胶原 N 端前肽（P1NP）和 I 型胶原 C 端交联肽（CTX）。至 2012 年确定髋部骨折事件的发生率。使用 Pearson 相关系数分析 TSH 和 FT4 与 BTMs 的基线关联，并使用 Cox 比例风险回归分析与新发髋部骨折的关联。
排除有甲状腺或骨疾病的男性后，有 3338 名男性进行了分析。其中，117 名男性为甲状腺功能正常，135 名男性为亚临床甲状腺功能减退，86 名男性为亚临床甲状腺功能亢进。患有亚临床甲状腺疾病的男性年龄较大，而患有亚临床甲状腺功能亢进的男性的肌酐水平低于其他组。经多变量分析，FT4、TSH 或亚临床甲状腺功能障碍与基线时的 BTMs 之间没有关联。在我们的研究人群中，亚临床甲状腺功能障碍、TSH 或 FT4 均不能预测髋部骨折的发生。
在甲状腺功能正常的老年男性中，TSH 和 FT4 与 BTMs 或新发髋部骨折无关。我们的研究结果与先前在绝经后女性中描述的结果不同。
