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Association Between Subclinical Thyroid Dysfunction and Fracture Risk.

Natalie R Daya1, Anna Fretz2, Seth S Martin1,3

  • 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

JAMA Network Open
|November 8, 2022
PubMed
Summary
This summary is machine-generated.

Subclinical hyperthyroidism, indicated by low thyrotropin levels, is an independent risk factor for fractures. Early screening and monitoring for subclinical hyperthyroidism are recommended to prevent bone mineral disease.

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Area of Science:

  • Endocrinology
  • Bone Metabolism
  • Epidemiology

Background:

  • Clinical hyperthyroidism accelerates bone resorption, increasing fracture risk.
  • The link between subclinical hyperthyroidism and fracture risk is not well-established.

Purpose of the Study:

  • To investigate the association between subclinical thyroid dysfunction and fracture risk.
  • To determine if subclinical hyperthyroidism is an independent risk factor for fractures.

Main Methods:

  • A cohort study of 10,946 participants from the Atherosclerosis Risk in Communities Study (1987-2019).
  • Thyrotropin and free thyroxine levels were measured; subclinical hyperthyroidism defined as thyrotropin <0.56 mIU/L.
  • Incident fractures were ascertained through hospitalization codes and Medicare claims.

Main Results:

  • During a median follow-up of 21 years, 3,556 incident fractures occurred.
  • Subclinical hyperthyroidism was associated with a 1.34-fold increased hazard ratio for fracture (95% CI, 1.09-1.65).
  • Subclinical hypothyroidism showed no significant association with fracture risk (HR, 0.90; 95% CI, 0.77-1.05).

Conclusions:

  • Subclinical hyperthyroidism is an independent risk factor for fracture.
  • Low thyrotropin levels (<0.56 mIU/L) are significantly associated with increased fracture risk.
  • Aggressive screening and monitoring for subclinical hyperthyroidism may help prevent bone mineral disease.