You are here
Subclinical thyroid dysfunction and fracture risk: a meta-analysis.
Friday,2015-08-28 10:09 America/Los_Angeles — zdrager
| Title | Subclinical thyroid dysfunction and fracture risk: a meta-analysis. |
| Publication Type | Journal Article |
| Year of Publication | 2015 |
| Authors | Blum, MR, Bauer, DC, Collet, T-H, Fink, HA, Cappola, AR, da Costa, BR, Wirth, CD, Peeters, RP, Asvold, BO, Elzen, WPJ den, Luben, RN, Imaizumi, M, Bremner, AP, Gogakos, A, Eastell, R, Kearney, PM, Strotmeyer, ES, Wallace, ER, Hoff, M, Ceresini, G, Rivadeneira, F, Uitterlinden, AG, Stott, DJ, Westendorp, RGJ, Khaw, K-T, Langhammer, A, Ferrucci, L, Gussekloo, J, Williams, GR, Walsh, JP, Jüni, P, Aujesky, D, Rodondi, N |
| Corporate/Institutional Authors | Thyroid Studies Collaboration, |
| Journal | JAMA |
| Volume | 313 |
| Issue | 20 |
| Pagination | 2055-65 |
| Date Published | 2015 May 26 |
| ISSN | 1538-3598 |
| Keywords | Adolescent, Adult, Aged, Aged, 80 and over, Female, Fractures, Bone, Hip Fractures, Humans, Hyperthyroidism, Hypothyroidism, Male, Middle Aged, Risk Factors, Spinal Fractures, Thyrotropin, Young Adult |
| Abstract | <p><b>IMPORTANCE: </b>Associations between subclinical thyroid dysfunction and fractures are unclear and clinical trials are lacking.</p><p><b>OBJECTIVE: </b>To assess the association of subclinical thyroid dysfunction with hip, nonspine, spine, or any fractures.</p><p><b>DATA SOURCES AND STUDY SELECTION: </b>The databases of MEDLINE and EMBASE (inception to March 26, 2015) were searched without language restrictions for prospective cohort studies with thyroid function data and subsequent fractures.</p><p><b>DATA EXTRACTION: </b>Individual participant data were obtained from 13 prospective cohorts in the United States, Europe, Australia, and Japan. Levels of thyroid function were defined as euthyroidism (thyroid-stimulating hormone [TSH], 0.45-4.49 mIU/L), subclinical hyperthyroidism (TSH <0.45 mIU/L), and subclinical hypothyroidism (TSH ≥4.50-19.99 mIU/L) with normal thyroxine concentrations.</p><p><b>MAIN OUTCOME AND MEASURES: </b>The primary outcome was hip fracture. Any fractures, nonspine fractures, and clinical spine fractures were secondary outcomes.</p><p><b>RESULTS: </b>Among 70,298 participants, 4092 (5.8%) had subclinical hypothyroidism and 2219 (3.2%) had subclinical hyperthyroidism. During 762,401 person-years of follow-up, hip fracture occurred in 2975 participants (4.6%; 12 studies), any fracture in 2528 participants (9.0%; 8 studies), nonspine fracture in 2018 participants (8.4%; 8 studies), and spine fracture in 296 participants (1.3%; 6 studies). In age- and sex-adjusted analyses, the hazard ratio (HR) for subclinical hyperthyroidism vs euthyroidism was 1.36 for hip fracture (95% CI, 1.13-1.64; 146 events in 2082 participants vs 2534 in 56,471); for any fracture, HR was 1.28 (95% CI, 1.06-1.53; 121 events in 888 participants vs 2203 in 25,901); for nonspine fracture, HR was 1.16 (95% CI, 0.95-1.41; 107 events in 946 participants vs 1745 in 21,722); and for spine fracture, HR was 1.51 (95% CI, 0.93-2.45; 17 events in 732 participants vs 255 in 20,328). Lower TSH was associated with higher fracture rates: for TSH of less than 0.10 mIU/L, HR was 1.61 for hip fracture (95% CI, 1.21-2.15; 47 events in 510 participants); for any fracture, HR was 1.98 (95% CI, 1.41-2.78; 44 events in 212 participants); for nonspine fracture, HR was 1.61 (95% CI, 0.96-2.71; 32 events in 185 participants); and for spine fracture, HR was 3.57 (95% CI, 1.88-6.78; 8 events in 162 participants). Risks were similar after adjustment for other fracture risk factors. Endogenous subclinical hyperthyroidism (excluding thyroid medication users) was associated with HRs of 1.52 (95% CI, 1.19-1.93) for hip fracture, 1.42 (95% CI, 1.16-1.74) for any fracture, and 1.74 (95% CI, 1.01-2.99) for spine fracture. No association was found between subclinical hypothyroidism and fracture risk.</p><p><b>CONCLUSIONS AND RELEVANCE: </b>Subclinical hyperthyroidism was associated with an increased risk of hip and other fractures, particularly among those with TSH levels of less than 0.10 mIU/L and those with endogenous subclinical hyperthyroidism. Further study is needed to determine whether treating subclinical hyperthyroidism can prevent fractures.</p> |
| DOI | 10.1001/jama.2015.5161 |
| Alternate Journal | JAMA |
| PubMed ID | 26010634 |
| PubMed Central ID | PMC4729304 |
| Grant List | G1000143 / / Medical Research Council / United Kingdom HHSN268200800007C / / PHS HHS / United States HHSN268201200036C / / PHS HHS / United States MR/K006312/1 / / Medical Research Council / United Kingdom N01-AG-6-2101 / AG / NIA NIH HHS / United States N01-AG-6-2103 / AG / NIA NIH HHS / United States N01-AG-6-2106 / AG / NIA NIH HHS / United States N01HC55222 / HC / NHLBI NIH HHS / United States N01HC85079 / HC / NHLBI NIH HHS / United States N01HC85080 / HC / NHLBI NIH HHS / United States N01HC85081 / HC / NHLBI NIH HHS / United States N01HC85082 / HC / NHLBI NIH HHS / United States N01HC85083 / HC / NHLBI NIH HHS / United States N01HC85086 / HC / NHLBI NIH HHS / United States R01-AG028050 / AG / NIA NIH HHS / United States R01-NR012459 / NR / NINR NIH HHS / United States R01AG023629 / AG / NIA NIH HHS / United States U01 AG027810 / AG / NIA NIH HHS / United States U01 AG042124 / AG / NIA NIH HHS / United States U01 AG042139 / AG / NIA NIH HHS / United States U01 AG042140 / AG / NIA NIH HHS / United States U01 AG042143 / AG / NIA NIH HHS / United States U01 AG042145 / AG / NIA NIH HHS / United States U01 AG042168 / AG / NIA NIH HHS / United States U01 AR066160 / AR / NIAMS NIH HHS / United States U01AG027810 / AG / NIA NIH HHS / United States U01AG042124 / AG / NIA NIH HHS / United States U01AG042139 / AG / NIA NIH HHS / United States U01AG042140 / AG / NIA NIH HHS / United States U01AG042143 / AG / NIA NIH HHS / United States U01AG042145 / AG / NIA NIH HHS / United States U01AG042168 / AG / NIA NIH HHS / United States U01AR066160 / AR / NIAMS NIH HHS / United States U01HL080295 / HL / NHLBI NIH HHS / United States UL1TR000128 / TR / NCATS NIH HHS / United States / / Cancer Research UK / United Kingdom / / Medical Research Council / United Kingdom |