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Subclinical thyroid dysfunction associated with increased fracture risk in older men
Lee JS. Arch Intern Med. 2010;170:1876-1883.
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Older men with subclinical thyroid dysfunction are at an increased risk for hip fracture, according to data from a prospective study. Based on these results, researchers concluded that such patients should undergo clinical evaluation to determine their risk for fracture.
From June 1989 to May 1990, the study enrolled 3,567 men and women aged 65 years or older with subclinical hypothyroidism, hyperthyroidism or euthyroidism. Patients were followed through 2004, for a median follow-up of 13 years. The primary outcome was HR of confirmed incident hip fracture in these patients.
Hip fracture occurred among 1,372 men, of whom 27.5% had thyroid dysfunction at baseline. Hypothyroidism was associated with a 1.86-fold increased hazard for a subsequent fracture compared with euthyroid men (95% CI, 1.09-3.16). After adjusting for confounders and fracture risk fractures (such as time-varying covariates for thyroid-altering medication use and anti-osteoporosis medication use during follow-up), men with hypothyroidism had a 2.31-fold increased hazard for fractures (95% CI, 1.25-4.27). Compared with euthyroid men, those with subclinical hyperthyroidism had an age-adjusted 3.07-fold higher hazard for hip fracture (95% CI, 1.11-8.46); this was based on four men with an incident hip fracture. Multivariable analysis revealed that men with subclinical hyperthyroidism had a borderline-significant increased hazard for fracture, with a wide 95% CI (3.27-fold; 95% CI, 0.99-11.30), according to the researchers.
The HR for men with endogenous subclinical hyperthyroidism was 4.91 (95% CI, 1.13-21.27) and 2.45 for those with endogenous subclinical hypothyroidism (95% CI, 1.27-4.73), after excluding those with thyroid-altering drug use at baseline.
Among women, 359 had subclinical hypothyroidism and 142 had subclinical hyperthyroidism. Incidence of hip fracture was 8.93 in those with hypothyroidism and 10.9 in those with hyperthyroidism vs. 10.18 in euthyroid women (n=1,694). The researchers did not observe a clear connection between subclinical thyroid dysfunction and fracture in women.
“This study suggests that older men with subclinical hyperthyroidism and hypothyroidism, including mild subclinical hypothyroidism (thyroid-stimulating hormone level, <10 mIU/L), should undergo clinical evaluation regarding their risk of hip fracture,” the researchers wrote. “Future studies should address directly whether correction of subclinical thyroid dysfunction in these men will reduce their hip fracture risk. If confirmed, these study results will provide evidence to guide clinical recommendations about subclinical thyroid dysfunction.”
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