Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Osteoporosis Center, Center for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-413 45, Sweden.
Department of Internal Medicine, Region Västra Götaland, Skaraborg Central Hospital, Skövde SE-541 85, Sweden.
J Bone Miner Res. 2024 Mar 4;39(1):50-58. doi: 10.1093/jbmr/zjad005.
Overt and subclinical hyperthyroidism are associated with an increased fracture risk, but whether thyroid hormones are associated with fracture risk in individuals with normal thyroid-stimulating hormone (TSH) has mostly been investigated in women. Therefore, we investigated if serum levels of free thyroxine (FT4) or TSH are associated with fracture risk in Swedish men. We followed (median 12.2 yr) elderly men (n = 1825; mean age 75, range 69-81 yr) participating in the Gothenburg and Malmö subcohorts of the prospective, population-based MrOS-Sweden study. The statistical analyses included Cox proportional hazards regression. Men receiving levothyroxine treatment were excluded. In our total cohort, serum FT4 (per SD increase) was associated with increased risk of major osteoporotic fractures (MOFs; n = 479; fully adjusted hazard ratio [HR] 1.14, 95% CI, 1.05-1.24) and hip fractures (n = 207; HR 1.18, 95% CI, 1.04-1.33). Also, in men with normal TSH (n = 1658), FT4 (per SD increase) was significantly associated with increased risk of MOF and hip fractures. Furthermore, men in the highest FT4 quartile had a 1.5-fold increase in hip fracture risk compared with men in the three lower FT4 quartiles, both in the total population and in men with normal TSH (fully adjusted: HR 1.45, 95% CI, 1.04-2.02 and HR 1.51, 95% CI, 1.07-2.12, respectively). In contrast, the risk of MOF was not statistically different in the highest FT4 quartile compared with the three lower FT4 quartiles. Finally, serum TSH was not associated with fracture risk after full adjustment for covariates. In conclusion, serum FT4, but not serum TSH, is a predictor of hip fracture risk in elderly Swedish men. Additionally, there was an association between FT4 (per SD increase) and the risk of MOF.
显性和亚临床甲状腺功能亢进与骨折风险增加有关，但甲状腺激素与甲状腺刺激素 (TSH) 正常的个体的骨折风险之间的关系主要在女性中进行了研究。因此，我们研究了游离甲状腺素 (FT4) 或 TSH 血清水平是否与瑞典男性的骨折风险相关。我们随访了（中位数 12.2 年）参加前瞻性、基于人群的 MrOS-Sweden 研究哥德堡和马尔默亚队列的老年男性（n=1825；平均年龄 75 岁，范围 69-81 岁）。统计分析包括 Cox 比例风险回归。排除接受左甲状腺素治疗的男性。在我们的总队列中，血清 FT4（每标准差增加）与主要骨质疏松性骨折（MOF；n=479；完全调整后的危险比 [HR] 1.14，95%CI，1.05-1.24）和髋部骨折（n=207；HR 1.18，95%CI，1.04-1.33）风险增加相关。此外，在 TSH 正常的男性（n=1658）中，FT4（每标准差增加）与 MOF 和髋部骨折风险增加显著相关。此外，与三个较低 FT4 四分位的男性相比，最高 FT4 四分位的男性髋部骨折风险增加了 1.5 倍，无论是在总人群中还是在 TSH 正常的男性中（完全调整：HR 1.45，95%CI，1.04-2.02 和 HR 1.51，95%CI，1.07-2.12）。相反，在最高 FT4 四分位与三个较低 FT4 四分位相比，MOF 的风险没有统计学差异。最后，在充分调整协变量后，血清 TSH 与骨折风险无关。总之，血清 FT4，但不是血清 TSH，是瑞典老年男性髋部骨折风险的预测指标。此外，FT4（每标准差增加）与 MOF 的风险之间存在关联。
