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

不适当使用甲状腺激素替代品对老年男性的影响

基本信息

批准号：
10591891
负责人：
Maria Papaleontiou
金额：
$ 8.63万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-15 至 2022-11-30
项目状态：
已结题

项目摘要

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.

项目总结/摘要过度使用甲状腺激素（即，根据生化结果，处方剂量过高）及其误用（即，因适应症不适当而开始）可能会对骨骼健康和导致骨质流失和骨折。这是至关重要的，因为髋部骨折死亡率在一年内，老年人髋部骨折的死亡率高达37%。19 -22 女性23 -25，大多数研究集中在绝经后女性26 -31，男性研究很少。32 -34 年龄和甲状腺激素替代需求之间的关系是一个激烈的争论，因为风险- 老年人治疗的受益率存在争议。如果提供者假设所有人都被治疗同样，无论年龄大小，老年人都可能有过度治疗的风险，导致对骨骼健康此外，人们对影响供应商决策的因素知之甚少，甲状腺激素替代疗法在老年人中的应用拟议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级数据分析，我将检查老年男性甲状腺激素过度治疗和误用的比率（具体目标1a），并确定甲状腺激素过度治疗和滥用与老年男性骨骼风险之间的关系（具体目标1b）。通过全国VA供应商调查，我将确定供应商态度的影响，老年人甲状腺激素替代的过度治疗和误用（具体目标2）。这个应用程序的总体目标是为候选人的成长和职业生涯奠定基础发展成为一个独立的卫生服务研究员，在老龄化研究领域的专业知识，甲状腺学通过拟议的研究项目，PI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，最终目标是开发工具，不断增长的亚群。在拟议的五年奖励期内，已确定：1）发展老龄化领域卫生服务研究的专门知识，特别是解决老年人甲状腺疾病管理的障碍; 2）发展以下方面的专业知识研究设计和数据收集方法，特别注重调查设计; 3）发展以下方面的专门知识：数据分析和解释，特别关注先进的生物统计方法; 4）开发在老年学和老年医学的临床和研究方面的专门知识和学术知识，高质量，临床相关的老龄化研究和5）发展成为一个独立的研究领域，以甲状腺学为重点的老龄化学术研究。有利的体制环境也是候选人职业发展和成长的基础。密歇根大学因其在卫生服务研究、内分泌学和老年医学，提供了一个优秀的和支持性的研究环境。