The Effect of Inappropriate Use of Thyroid Hormone Replacement in Older Men

 描述(申请人提供)：在老年人中过度使用甲状腺激素(即根据生化结果开出剂量过高的处方)和滥用甲状腺激素(即开始使用不适当的适应症)可能会对骨骼健康产生不利影响，并导致骨丢失和骨折。这一点至关重要，因为骨折一年内老年人的髋部骨折死亡率高达37%。19-22尽管男性髋部骨折后的死亡率高于女性23-25岁，但大多数研究都集中在绝经后女性26-31岁，而对男性的研究很少。32-34年龄和甲状腺激素替代需求之间的关系是一场激烈的辩论，因为老年人治疗的风险-益处比率存在争议。如果医疗服务提供者认为所有人无论年龄大小都得到同样的待遇，那么老年人可能会面临过度治疗的风险，从而对骨骼健康造成不利影响。此外，对影响老年人使用甲状腺激素替代的提供者决策的因素知之甚少。拟议的项目将涉及以下目标：通过对退伍军人健康管理局国家患者护理数据库的二级数据分析，我将审查老年男子甲状腺激素过度治疗和滥用的比率(具体目标1a)，并确定老年男子甲状腺激素过度治疗与滥用和骨骼风险之间的联系(具体目标1b)。通过全国退伍军人管理局提供者调查，我将确定提供者对老年人过度使用和滥用甲状腺激素替代治疗的态度的影响(具体目标2)。这项申请的总体目标是为候选人的成长和职业发展奠定基础，使其成为一名独立的卫生服务研究人员，在甲状腺领域拥有衰老研究方面的专业知识。通过拟议的研究项目，PI计划在老年人甲状腺疾病管理挑战领域开发一个新的利基市场，最终目标是开发工具，为这一不断增长的亚群量身定做治疗。在拟议的五年奖励期内，已确定了以下职业发展领域：1)发展老龄领域保健服务研究方面的专门知识，特别是解决老龄人口中甲状腺疾病管理方面的障碍；2)发展研究设计和数据收集方法方面的专门知识，特别注重调查设计；3)发展数据分析和解释方面的专门知识，特别注重先进的生物统计方法；4)在老年学和老年病学的临床和研究方面发展专业知识和学术知识，这是进行高质量、与临床相关的老龄研究所必需的；5)发展成为老龄学术研究领域的独立调查者，重点是甲状腺学。支持性的制度环境对候选人的职业发展和成长也是至关重要的。密歇根大学在卫生服务研究、内分泌学和老年病学方面的卓越表现得到公认，它提供了一个出色和支持性的研究环境。

 DESCRIPTION (provided by applicant): Overtreatment with thyroid hormone (i.e., prescription at doses that are too high based on biochemical results) and its misuse (i.e., initiation for inappropriate indications) in older individuals may have adverse effects on bone health and lead to bone loss and fractures. This is critical as hip fracture mortality rates within the year of fracture reach up to 37% in older adults.19-22 Despite a higher death rate post hip fracture in men versus women23-25, most studies have focused on post-menopausal women26-31 and studies in men are sparse.32-34 The relationship between age and thyroid hormone replacement requirements is a heated debate, as the risk- benefit ratio of treatment for older adults is controversial. If providers assume that all individuals are treated similarly regardless f age, then older adults may be at risk for overtreatment, resulting in adverse effects on bone health. Furthermore, very little is known about factors that influence providers' decision-making regarding use of thyroid hormone replacement in older adults. The proposed project will address the following aims: Through secondary data analysis of the Veterans Health Administration National Patient Care Database, I will examine the rates of thyroid hormone overtreatment and misuse in older men (Specific Aim 1a) and determine the association between thyroid hormone overtreatment and misuse and skeletal risk in older men (Specific Aim 1b). Through national VA provider surveys, I will determine the influence of provider attitudes regarding overtreatment with and misuse of thyroid hormone replacement in older adults (Specific Aim 2). The overall goal of this application is to provide the groundwork for the candidate's growth and career development into an independent health services researcher with expertise in aging research in the field of thyroidology. With the proposed research project, the PI plans to develop a new niche in the field of thyroid disease management challenges in older adults, with an ultimate goal to develop tools to tailor treatment to this growing subpopulation. The following areas of career development for the proposed five-year award period have been identified: 1) to develop expertise in health services research in the field of aging, specifically addressing barriers to management of thyroid disorders in the aging population; 2) to develop expertise in study design and data collection methods, with a special focus on survey design; 3) to develop expertise in data analysis and interpretation, with a special focus on advanced biostatistical methods; 4) to develop expertise and scholarship in clinical and research aspects of gerontology and geriatrics, necessary to conduct high quality, clinically relevant aging research and 5) to develop into an independent investigator in the field of academic research in aging with a focus on thyroidology. A supportive institutional environment is also fundamental to the candidate's career development and growth. The University of Michigan, recognized for its excellence in health services research, endocrinology and geriatrics, provides an outstanding and supportive research environment.