Nguyen T T, Heath H, Bryant S C, O'Fallon W M, Melton L J
Division of Endocrinology and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
J Bone Miner Res. 1997 Jul;12(7):1092-9. doi: 10.1359/jbmr.1997.12.7.1092.
Bone mass is purportedly reduced by an endogenous or exogenous excess of thyroid hormone or, perhaps, by calcitonin deficiency. Patients who have undergone thyroidectomy could be subject to all of these effects, yet their practical implications in terms of fracture risk are poorly defined. Interpretation is further hampered by the focus on women, where results may be influenced by involutional osteoporosis. Consequently, we assessed the potential for fractures among the 136 Rochester, Minnesota men who underwent thyroidectomy between 1935 and 1979, relative to a group of age-matched control men from the community. With 2194 person-years of follow-up in each group, survival free of any fracture of vertebra, proximal humerus, distal forearm, pelvis, or proximal femur was similar in the two groups (p = 0.23), and the relative risk of any of these fractures for thyroidectomized patients versus their controls was increased only 1.5-fold (95% CI, 0.7-3.2). The difference was entirely accounted for by a statistically significant excess of proximal femur fractures in the men with thyroidectomy. Risk factors for fractures among men with thyroidectomy included greater age at surgery, greater extent of surgery, and the presence of risk factors for secondary osteoporosis. Thus, thyroidectomy, performed mainly for adenoma or goiter, seems to have little overall influence on the risk of age-related fractures in men. However, the association with hip fractures requires further evaluation.
据推测，内源性或外源性甲状腺激素过量，或者可能是降钙素缺乏，会导致骨量减少。接受甲状腺切除术的患者可能会受到所有这些影响，然而，它们在骨折风险方面的实际影响尚不清楚。由于研究重点是女性，而女性的结果可能会受到退行性骨质疏松症的影响，这进一步阻碍了对结果的解释。因此，我们评估了1935年至1979年间在明尼苏达州罗切斯特市接受甲状腺切除术的136名男性发生骨折的可能性，并与一组年龄匹配的社区对照男性进行了比较。每组随访2194人年，两组中无椎骨、肱骨近端、前臂远端、骨盆或股骨近端骨折的生存率相似（p = 0.23），甲状腺切除患者与对照组相比，发生这些骨折的相对风险仅增加了1.5倍（95% CI，0.7 - 3.2）。这种差异完全是由于甲状腺切除男性中股骨近端骨折在统计学上显著过量所致。甲状腺切除男性骨折的风险因素包括手术时年龄较大、手术范围较大以及存在继发性骨质疏松症的风险因素。因此，主要因腺瘤或甲状腺肿而进行的甲状腺切除术，似乎对男性与年龄相关的骨折风险总体影响不大。然而，与髋部骨折的关联需要进一步评估。
