TY - JOUR
T1 - Thyrotropin levels within the lower normal range are associated with an increased risk of hip fractures in euthyroid women, but not men, over the age of 65 years
AU - Leader, Avi
AU - Ayzenfeld, Racheli Heffez
AU - Lishner, Michael
AU - Cohen, Efrat
AU - Segev, David
AU - Hermoni, Doron
PY - 2014/8
Y1 - 2014/8
N2 - Context: The contemporary literature on the relationship between serum TSH levels and osteoporotic fractures in euthyroid individuals is limited by conflicting results and analyses conducted on a small number of fractures. Objective: Our objective was to examine the association between the normal range of variation of TSHandthe incidence of hip fractures in maleandfemale euthyroid patientsaged65 years or older. Design and Setting: We performed a population-based historical prospective cohort study within the Clalit Health Services population. Participants: Clalit Health Services members aged ≥65 years with at least 1 TSH measurement during the year 2004. We excluded patients with preexisting hip fracture, thyroid disease, malignancy, or chronic kidney disease. Outcome Measures: The primary outcome was hip fracture, and the secondary outcome was any other osteoporotic fracture. Statistical Analysis: Adjusted odds ratios comparing episodes of each outcome across 3 TSH groups (low, 0.35-1.6 mIU/L; intermediate, 1.7-2.9 mIU/L; high, 3-4.2 mIU/L) were generated using logistic regression models. Results: The 14 325 included participants suffered from 514 hip fractures (mean follow-up, 102 = 3 months). Women, but not men, in the lowest TSH group had a higher incidence of hip fractures (odds ratio = 1.28, 95% confidence interval = 1.03-1.59, P = .029) when compared with the intermediate group, after multivariate adjustment for age, comorbidities, and use of drugs affecting bone metabolism. There wasnodifference in hip fracture incidence between intermediateand high-TSH groups. No association was found between TSH levels and other osteoporotic fractures. Conclusions: TSH levels within the lower normal range are associated with an increased risk of hip fractures in euthyroid women, but not men, aged 65 years and more.
AB - Context: The contemporary literature on the relationship between serum TSH levels and osteoporotic fractures in euthyroid individuals is limited by conflicting results and analyses conducted on a small number of fractures. Objective: Our objective was to examine the association between the normal range of variation of TSHandthe incidence of hip fractures in maleandfemale euthyroid patientsaged65 years or older. Design and Setting: We performed a population-based historical prospective cohort study within the Clalit Health Services population. Participants: Clalit Health Services members aged ≥65 years with at least 1 TSH measurement during the year 2004. We excluded patients with preexisting hip fracture, thyroid disease, malignancy, or chronic kidney disease. Outcome Measures: The primary outcome was hip fracture, and the secondary outcome was any other osteoporotic fracture. Statistical Analysis: Adjusted odds ratios comparing episodes of each outcome across 3 TSH groups (low, 0.35-1.6 mIU/L; intermediate, 1.7-2.9 mIU/L; high, 3-4.2 mIU/L) were generated using logistic regression models. Results: The 14 325 included participants suffered from 514 hip fractures (mean follow-up, 102 = 3 months). Women, but not men, in the lowest TSH group had a higher incidence of hip fractures (odds ratio = 1.28, 95% confidence interval = 1.03-1.59, P = .029) when compared with the intermediate group, after multivariate adjustment for age, comorbidities, and use of drugs affecting bone metabolism. There wasnodifference in hip fracture incidence between intermediateand high-TSH groups. No association was found between TSH levels and other osteoporotic fractures. Conclusions: TSH levels within the lower normal range are associated with an increased risk of hip fractures in euthyroid women, but not men, aged 65 years and more.
UR - http://www.scopus.com/inward/record.url?scp=84905836983&partnerID=8YFLogxK
U2 - 10.1210/jc.2013-2474
DO - 10.1210/jc.2013-2474
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C2 - 24885627
AN - SCOPUS:84905836983
SN - 0021-972X
VL - 99
SP - 2665
EP - 2673
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 8
ER -