Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
Medicine (Baltimore). 2024 Nov 1;103(44):e40173. doi: 10.1097/MD.0000000000040173.
Previous studies have demonstrated that thyroid hormone plays an important role in normal bone development, bone metabolism, and establishment of peak bone mass. However, the correlation of thyroid status with bone mineral content (BMC), bone mineral density (BMD), and osteoporotic vertebral fracture (OVF) is rarely discussed. The current study probes into the potential association between thyroid status and spinal BMC, BMD, and OVF from a novel perspective of thyroid function (TF) and sensitivity to thyroid hormone based on the National Health and Nutrition Examination Survey database. A total of 1844 participants were included in this study. The association of thyroid status with outcome variables, like spinal BMC, BMD, and OVF, was analyzed using thyroid function indices and sensitivity to thyroid hormone indices as influence factors. The correlation of them were assessed using univariate and multivariable weighted linear regression, weighted logistic regression models, restricted cubic spline model, and subgroup analyses. The results of this study showed that the association of free triiodothyronine (FT3)/free thyroxine (FT4) with BMC remained negatively associated after adjustment for all covariates. Higher thyroid peroxidase antibody (TPOAb) was significantly associated with an increased risk of developing OVF in both unadjusted and adjusted models. In addition, the results of the restricted cubic spline model were consistent with the weighted multivariate regression analysis after adjustment. The results of this cross-sectional study showed that higher FT3/FT4 and TPOAb were associated with decreased spinal BMC and the increased risk of OVF, indicating a complex link between thyroid status and bone health. Therefore, patients with hyperthyroidism, hypothyroidism, autoimmune thyroid disease, or abnormal peripheral thyroid sensitivity, especially who with elevated TPOAb or FT3/FT4, should focus on the prevention of vertebral osteopenia, osteoporosis, and OVF.
先前的研究表明，甲状腺激素在正常骨骼发育、骨代谢和峰值骨量的建立中起着重要作用。然而，甲状腺状态与骨矿物质含量（BMC）、骨矿物质密度（BMD）和骨质疏松性椎体骨折（OVF）之间的相关性很少被讨论。本研究从甲状腺功能（TF）和甲状腺激素敏感性的新视角，基于国家健康和营养检查调查数据库，探讨了甲状腺状态与脊柱 BMC、BMD 和 OVF 之间的潜在相关性。共有 1844 名参与者纳入本研究。采用甲状腺功能指数和甲状腺激素敏感性指数作为影响因素，分析甲状腺状态与脊柱 BMC、BMD 和 OVF 等结局变量的相关性。使用单变量和多变量加权线性回归、加权逻辑回归模型、限制性立方样条模型和亚组分析评估它们之间的相关性。本研究结果表明，在调整所有协变量后，游离三碘甲状腺原氨酸（FT3）/游离甲状腺素（FT4）与 BMC 的相关性仍呈负相关。甲状腺过氧化物酶抗体（TPOAb）升高与未调整和调整模型中 OVF 的发病风险增加显著相关。此外，调整后的限制性立方样条模型结果与加权多变量回归分析结果一致。这项横断面研究的结果表明，较高的 FT3/FT4 和 TPOAb 与脊柱 BMC 降低和 OVF 风险增加相关，表明甲状腺状态与骨骼健康之间存在复杂的联系。因此，患有甲亢、甲减、自身免疫性甲状腺疾病或外周甲状腺敏感性异常的患者，尤其是 TPOAb 或 FT3/FT4 升高的患者，应注意预防椎体骨量减少、骨质疏松症和 OVF。
