Wu Xuelun, Zhai Furui, Chang Ailing, Wei Jing, Guo Yanan, Zhang Jincheng
Department of Endocrinology, Cangzhou Central Hospital, 16 Xinhua West Road, Cangzhou City 061000, Hebei Province, PR China.
Gynecological clinic, Cangzhou Central Hospital, Cangzhou City, Hebei Province, PR China.
Ther Adv Chronic Dis. 2023 Aug 1;14:20406223231189230. doi: 10.1177/20406223231189230. eCollection 2023.
Thyroid hormones are known to regulate bone metabolism and may influence bone mineral density (BMD), as well as the risk of osteoporosis (OP) and fractures in patients with type 2 diabetes mellitus (T2DM). Recently, sensitivity to thyroid hormone indices has been linked with T2DM and OP independently. However, the relationship between thyroid hormone sensitivity and OP in euthyroid T2DM patients has yet to be investigated.
The aim of this study was to determine the association between sensitivity to thyroid hormone indices and the risk of OP in euthyroid patients with T2DM.
This study employed a retrospective, cross-sectional design and utilized data acquired from the Cangzhou Central Hospital in China between 2019 and 2020.
We retrospectively analyzed the data of 433 patients with T2DM for anthropometric measurements, clinical laboratory test results, and BMD. The thyroid-stimulating hormone index, thyrotroph thyroxine resistance index, and thyroid feedback quantile-based index (TFQI) were calculated to determine thyroid hormone sensitivity. Finally, multivariable logistic regression, generalized additive models, and subgroup analysis were performed to detect the association between sensitivity to thyroid hormone indices and the risk of OP in these patients.
We did not observe a statistically significant linear relationship between sensitivity to thyroid hormones indices and OP after covariate adjustment. However, a nonlinear relationship existed between TFQI and the prevalence of OP. The inflection point of the TFQI was at -0.29. The effect sizes (odds ratio) on the left and right of the inflection point were 0.07 [95% confidence interval (CI): 0.01-0.71; = 0.024] and 2.78 (95% CI: 1.02-7.58; = 0.046), respectively. This trend was consistent in older female patients with higher body mass index (BMI; 25-30 kg/m).
An approximate U-shaped relationship was observed between sensitivity to thyroid hormone indices and OP risk in euthyroid patients with T2DM with variations in sex, age, and BMI. These findings provide a new perspective to elucidate the role of thyroid hormones in OP, specifically in patients with T2DM.
已知甲状腺激素可调节骨代谢，并可能影响骨密度（BMD）以及2型糖尿病（T2DM）患者的骨质疏松症（OP）风险和骨折风险。最近，甲状腺激素指标敏感性已分别与T2DM和OP相关联。然而，甲状腺激素敏感性与甲状腺功能正常的T2DM患者的OP之间的关系尚未得到研究。
本研究旨在确定甲状腺激素指标敏感性与甲状腺功能正常的T2DM患者的OP风险之间的关联。
本研究采用回顾性横断面设计，并利用了2019年至2020年期间从中国沧州市中心医院获取的数据。
我们回顾性分析了433例T2DM患者的人体测量数据、临床实验室检查结果和BMD。计算促甲状腺激素指数、促甲状腺素甲状腺素抵抗指数和基于甲状腺反馈分位数的指数（TFQI）以确定甲状腺激素敏感性。最后，进行多变量逻辑回归、广义相加模型和亚组分析，以检测这些患者中甲状腺激素指标敏感性与OP风险之间的关联。
在进行协变量调整后，我们未观察到甲状腺激素指标敏感性与OP之间存在统计学上显著的线性关系。然而，TFQI与OP患病率之间存在非线性关系。TFQI的拐点为-0.29。拐点左侧和右侧的效应大小（比值比）分别为0.07 [95%置信区间（CI）：0.01 - 0.71；P = 0.024]和2.78（95% CI：1.02 - 7.58；P = 0.046）。在体重指数（BMI；25 - 30 kg/m²）较高的老年女性患者中，这一趋势是一致的。
在甲状腺功能正常的T2DM患者中，观察到甲状腺激素指标敏感性与OP风险之间存在近似U形的关系，且存在性别、年龄和BMI差异。这些发现为阐明甲状腺激素在OP中的作用，特别是在T2DM患者中的作用，提供了一个新的视角。
