Risk for fracture in women with low serum levels of thyroid-stimulating hormone
Risk for fracture in women with low serum levels of thyroid-stimulating hormone
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DOI：
10.7326/0003-4819-134-7-200104030-00009
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发表时间：
2001-04-03
影响因子：
39.2
通讯作者：
Stone, KL
中科院分区：
文献类型：
--
作者：
Bauer, DC;Ettinger, B;Stone, KL
背景：生化证据表明，甲状腺功能亢进可能与低骨量有关，特别是在老年绝经后妇女中，但尚未对甲状腺功能和随后的骨折风险进行前瞻性研究。目的：探讨老年妇女低促甲状腺激素（TSH）水平与骨折的关系。设计：采用病例-队列抽样的前瞻性队列研究。环境：在美国的四个临床中心。患者：从1986年至1988年间以人群为基础的9704名女性中招募686名年龄大于65岁的女性，测量：跟骨骨量基线评估、脊柱x线摄影和甲状腺疾病史。平均随访3.7年后再次进行脊柱x线摄影；对非脊柱骨折进行集中诊断，对148名新发髋部骨折妇女、149名新发椎体骨折妇女和从队列中随机选择的398名妇女的基线血清进行促甲状腺激素测定。结果:在调整了年龄、既往甲状腺功能亢进史、自我评估健康状况以及雌激素和甲状腺激素的使用后，与TSH水平正常（0.5至5.5 mU/L）的女性相比，TSH水平低（小于或等于0.1 mU/L）的女性髋部骨折的风险增加了3倍（相对危险度，3.6 [95% CI， 1.0至12.9]），椎体骨折的风险增加了4倍（优势比，4.5 [CI， 1.3至15.6]）。甲状腺功能亢进史与髋部骨折风险增加两倍相关（相对危险度，2.2 [CI， 1.0至4.4]），但使用甲状腺激素本身与髋部骨折风险增加无关（相对危险度，0.5 [CI， 0.2至1.3]）。结论：65岁以上的女性血清TSH水平低，表明生理性甲状腺功能亢进，发生新的髋部和椎体骨折的风险增加。如果TSH水平正常，使用甲状腺激素本身不会增加骨折的风险。
Background: Biochemical evidence of hyperthyroidism may be associated with low bone mass, particularly in older postmenopausal women, but no prospective studies of thyroid function and subsequent fracture risk have been done.Objective: To examine the association between low levels of thyroid-stimulating hormone (TSH) and fracture in older women.Design: Prospective cohort study with case-cohort sampling.Setting: Four clinical centers in the United States. Patients: 686 women older than 65 years of age from a cohort of 9704 women recruited from population-based listings between 1986 and 1988,Measurements: Baseline assessment of calcaneal bone mass, spine radiography, and history of thyroid disease. Spine radiography was repeated after a mean follow-up of 3.7 years; nonspine fractures were centrally adjudicated, Thyroid-stimulating hormone was measured in sera obtained at baseline from 148 women with new hip fractures, 149 women with new vertebral fractures, and a subsample of 398 women randomly selected from the cohort.Results: After adjustment for age, history of previous hyperthyroidism, self-rated health, and use of estrogen and thyroid hormone, women with a low TSH level (less than or equal to0.1 mU/L) had a threefold increased risk for hip fracture (relative hazard, 3.6 [95% CI, 1.0 to 12.9]) and a fourfold increased risk for vertebral fracture (odds ratio, 4.5 [CI, 1.3 to 15.6]) compared with women who had normal TSH levels (0.5 to 5.5 mU/L), After adjustment for TSH level, a history of hyperthyroidism was associated with a twofold increase in hip fracture (relative hazard, 2.2 [CI, 1.0 to 4.4]), but use of thyroid hormone itself was not associated with increased risk for hip fracture (relative hazard, 0.5 [CI, 0.2 to 1.3]).Conclusions: Women older than 65 years of age who have low serum TSH levels, indicating physiologic hyperthyroidism, are at increased risk for new hip and vertebral fractures. Use of thyroid hormone itself does not increase risk for fracture if TSH levels are normal.