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

项目摘要/摘要 用甲状腺激素过度治疗(即根据生化结果开出剂量过高的处方) 而在老年人中滥用它(即开始使用不适当的适应症)可能会对 骨骼健康，并导致骨质流失和骨折。这一点至关重要，因为这一年内髋部骨折的死亡率 老年人骨折高达37%。19-22尽管男性髋部骨折后的死亡率高于 女性23-25岁，大多数研究集中在绝经后女性26-31岁，而对男性的研究很少。 年龄和甲状腺激素替代需求之间的关系是一个激烈的辩论，因为风险- 老年人治疗的受益比例是有争议的。如果提供者假设所有人都得到了治疗 同样，不考虑年龄，那么老年人可能面临过度治疗的风险，导致对 骨骼健康。此外，对影响供应商决策的因素知之甚少。 老年人甲状腺激素替代的使用情况。拟议的项目将实现以下目标： 通过对退伍军人健康管理局国家患者护理数据库的二次数据分析，我将 检查老年男性甲状腺激素过度治疗和滥用的比率(特定目标1a)，并确定 老年男性甲状腺激素过度治疗与滥用和骨骼风险的关系(特异性肿瘤) 目标1b)。通过全国退伍军人管理局提供商调查，我将确定提供商对以下方面的态度的影响 老年人甲状腺激素替代治疗过度和滥用(具体目标2)。 此应用程序的总体目标是为应聘者的成长和职业生涯奠定基础 发展成为独立的卫生服务研究人员，在老龄化研究领域拥有专业知识 甲状腺学。通过拟议的研究项目，国际甲状腺协会计划在甲状腺领域开发一个新的利基市场 老年人的疾病管理挑战，最终目标是开发针对此问题量身定做的治疗工具 不断增长的人口亚群。拟议五年奖励期的以下职业发展领域 已确定：1)在老龄领域发展保健服务研究方面的专门知识，特别是 解决老龄化人口中管理甲状腺疾病的障碍；2)在以下方面发展专门知识 研究设计和数据收集方法，特别注重调查设计；3)发展专门知识 数据分析和解释，特别注重先进的生物统计方法；4)开发 在老年学和老年病学的临床和研究方面的专业知识和学术知识， 高质量、与临床相关的衰老研究以及5)发展成为以下领域的独立研究人员 衰老方面的学术研究，重点放在甲状腺学。 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。 密歇根大学因其在卫生服务研究、内分泌学和 老年病学，提供了一个出色的和支持性的研究环境。

Project Summary/Abstract 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 of 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.