TY - JOUR
T1 - Subclinical Thyroid Dysfunction and Fracture Risk
T2 - A Meta-analysis
AU - Blum, Manuel R
AU - Bauer, Douglas C
AU - Collet, Tinh-Hai
AU - Fink, Howard A
AU - Cappola, Anne R
AU - da Costa, Bruno R
AU - Wirth, Christina D
AU - Peeters, Robin P
AU - Åsvold, Bjørn O
AU - den Elzen, Wendy P J
AU - Luben, Robert N
AU - Imaizumi, Misa
AU - Bremner, Alexandra P
AU - Gogakos, Apostolos
AU - Eastell, Richard
AU - Kearney, Patricia M
AU - Strotmeyer, Elsa S
AU - Wallace, Erin R
AU - Hoff, Mari
AU - Ceresini, Graziano
AU - Rivadeneira, Fernando
AU - Uitterlinden, André G
AU - Stott, David J
AU - Westendorp, Rudi G J
AU - Khaw, Kay-Tee
AU - Langhammer, Arnuf
AU - Ferrucci, Luigi
AU - Gussekloo, Jacobijn
AU - Williams, Graham R
AU - Walsh, John P
AU - Jüni, Peter
AU - Aujesky, Drahomir
AU - Rodondi, Nicolas
AU - Thyroid Studies Collaboration
PY - 2015/5/26
Y1 - 2015/5/26
N2 - IMPORTANCE Associations between subclinical thyroid dysfunction and fractures are unclear and clinical trials are lacking. OBJECTIVE To assess the association of subclinical thyroid dysfunction with hip, nonspine, spine, or any fractures. DATA SOURCES AND STUDY SELECTION 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. DATA EXTRACTION Individual participant datawere obtained from 13 prospective cohorts in the United States, Europe, Australia, and Japan. Levels of thyroid functionwere 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. MAIN OUTCOME AND MEASURES The primary outcomewas hip fracture. Any fractures, nonspine fractures, and clinical spine fractures were secondary outcomes. RESULTS 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 euthyroidismwas 1.36 for hip fracture (95%CI, 1.13-1.64; 146 events in 2082 participants vs 2534 in 56 471); for any fracture, HRwas 1.28 (95%CI, 1.06-1.53; 121 events in 888 participants vs 2203 in 25 901); for nonspine fracture, HRwas 1.16 (95%CI, 0.95-1.41; 107 events in 946 participants vs 1745 in 21 722); and for spine fracture, HRwas 1.51 (95%CI, 0.93-2.45; 17 events in 732 participants vs 255 in 20 328). Lower TSHwas associated with higher fracture rates: for TSH of less than0.10 mIU/L, HRwas 1.61 for hip fracture (95%CI, 1.21-2.15; 47 events in 510participants); for any fracture, HRwas 1.98 (95%CI, 1.41-2.78; 44 events in 212 participants); for nonspine fracture, HRwas 1.61 (95%CI, 0.96-2.71; 32 events in 185 participants); and for spine fracture, HRwas 3.57 (95%CI, 1.88-6.78; 8 events in 162 participants). Riskswere 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 associationwas found between subclinical hypothyroidism and fracture risk. CONCLUSIONS AND RELEVANCE Subclinical hyperthyroidismwas 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.
AB - IMPORTANCE Associations between subclinical thyroid dysfunction and fractures are unclear and clinical trials are lacking. OBJECTIVE To assess the association of subclinical thyroid dysfunction with hip, nonspine, spine, or any fractures. DATA SOURCES AND STUDY SELECTION 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. DATA EXTRACTION Individual participant datawere obtained from 13 prospective cohorts in the United States, Europe, Australia, and Japan. Levels of thyroid functionwere 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. MAIN OUTCOME AND MEASURES The primary outcomewas hip fracture. Any fractures, nonspine fractures, and clinical spine fractures were secondary outcomes. RESULTS 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 euthyroidismwas 1.36 for hip fracture (95%CI, 1.13-1.64; 146 events in 2082 participants vs 2534 in 56 471); for any fracture, HRwas 1.28 (95%CI, 1.06-1.53; 121 events in 888 participants vs 2203 in 25 901); for nonspine fracture, HRwas 1.16 (95%CI, 0.95-1.41; 107 events in 946 participants vs 1745 in 21 722); and for spine fracture, HRwas 1.51 (95%CI, 0.93-2.45; 17 events in 732 participants vs 255 in 20 328). Lower TSHwas associated with higher fracture rates: for TSH of less than0.10 mIU/L, HRwas 1.61 for hip fracture (95%CI, 1.21-2.15; 47 events in 510participants); for any fracture, HRwas 1.98 (95%CI, 1.41-2.78; 44 events in 212 participants); for nonspine fracture, HRwas 1.61 (95%CI, 0.96-2.71; 32 events in 185 participants); and for spine fracture, HRwas 3.57 (95%CI, 1.88-6.78; 8 events in 162 participants). Riskswere 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 associationwas found between subclinical hypothyroidism and fracture risk. CONCLUSIONS AND RELEVANCE Subclinical hyperthyroidismwas 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.
KW - Adolescent
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Female
KW - Fractures, Bone
KW - Hip Fractures
KW - Humans
KW - Hyperthyroidism
KW - Hypothyroidism
KW - Male
KW - Middle Aged
KW - Risk Factors
KW - Spinal Fractures
KW - Thyrotropin
KW - Young Adult
U2 - 10.1001/jama.2015.5161
DO - 10.1001/jama.2015.5161
M3 - Journal article
C2 - 26010634
SN - 0098-7484
VL - 313
SP - 2055
EP - 2065
JO - J A M A: The Journal of the American Medical Association
JF - J A M A: The Journal of the American Medical Association
IS - 20
ER -