This article is more than 5 years old. Information may no longer be current.
Hip, other fracture risk related to subclinical hyperthyroidism
Click Here to Manage Email Alerts
An increased risk for hip and other fractures was found in patients with subclinical hyperthyroidism, especially among those with thyroid-stimulating hormone levels less than 0.1 mIU/L, but no association was found with subclinical hypothyroidism, according to recent study findings published in JAMA.
“Current guidelines recommend that treatment of subclinical hyperthyroidism should be strongly considered if TSH is persistently lower than 0.1 mIU/L in all individuals aged 65 years of older and that treatment should also be considered if TSH is low but at least 0.1 mIU/L in individuals who are at least 65 years old,” the researchers wrote. “Our results from pooling data of all available prospective cohorts, showing increased fracture risk in subclinical hyperthyroidism with even higher risk for participants with TSH levels of less than 0.1 mIU/L, are consistent with these recommendations.”
Nic olas Rodondi, MD, MAS, of the University of Bern in Switzerland, and colleagues conducted a meta-analysis using data from 13 prospective cohorts to determine the relationship between subclinical thyroid dysfunction with hip, nonspine, spine or any other fractures.
Through the cohorts, 70,298 participants (median age, 64 years; 61.3% women) were identified; 91% were euthyroid (TSH, 0.45-4.49 mIU/L), 5.8% had subclinical hypothyroidism (TSH, 4.5-19.99 mIU/L) and 3.2% had subclinical hyperthyroidism (TSH, less than 0.45 mIU/L).
Nearly 5% of participants experienced hip fracture, 9% experienced any fracture, 8.4% experienced nonspine fracture and 1.3% experienced spine fracture during 762,401 person-years of follow-up.
After adjustment for age and sex, subclinical hyperthyroidism compared with euthyroidism yielded HRs of 1.36 (95% CI, 1.13-1.64) for hip fracture, 1.28 (95% CI, 1.06-1.53) for any fracture, 1.16 (95% CI, 0.95-1.41) for nonspine fracture and 1.51 (95% CI, 0.93-2.45) for spine fracture. For all fracture outcomes, men had higher HRs compared with women. Lower TSH levels were related to higher risk for hip, any and spine fractures; however, levels of TSH lower than 0.1 mIU/L were not associated with an increased risk for nonspine fracture.
Overall, no increased risk for fracture was found with subclinical hypothyroidism.
“Subclinical hyperthyroidism was associated with an increased risk of hip and other fractures, particularly among those with TSH levels lower than 0.1 mIU/L and those with endogenous subclinical hyperthyroidism,” the researchers wrote. “Further study is needed to determine whether treating subclinical hyperthyroidism can prevent fractures, but until then, these data are the most up-to-date evidence for clinicians.” - by Amber Cox
Disclosure: Rodondi reports financial disclosures with the European Commission FP7-HEALTH-2011, Specific Programme “Cooperation” - Theme “Health” Investigator-driven clinical trials for therapeutic interventions in elderly populations. See the full study for a list of all other authors’ relevant financial disclosures.
Click Here to Manage Email Alerts