Association between subclinical thyroid dysfunction and change in bone mineral density in prospective cohorts.

Segna, D; Bauer, D C; Feller, M; Schneider, C; Fink, H A; Aubert, C E; Collet, T-H; Da Costa, B R; Fischer, K; Peeters, R P; Cappola, A R; Blum, M; van Dorland, H A; Robbins, J; Naylor, K; Eastell, R; Uitterlinden, A G; Rivadeneira Ramirez, F; Gogakos, A; Gussekloo, J; ... (2018). Association between subclinical thyroid dysfunction and change in bone mineral density in prospective cohorts. Journal of internal medicine, 283(1), pp. 56-72. Blackwell Scientific Publications 10.1111/joim.12688

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BACKGROUND Subclinical hyperthyroidism (SHyper) has been associated with increased risk of hip and other fractures, but the linking mechanisms remain unclear. OBJECTIVE To investigate the association between subclinical thyroid dysfunction and bone loss. METHODS Individual participant data analysis was performed after a systematic literature search in MEDLINE/EMBASE (1946-2016). Two reviewers independently screened and selected prospective cohorts providing baseline thyroid status and serial bone mineral density (BMD) measurements. We classified thyroid status as euthyroidism (thyroid-stimulating hormone [TSH] 0.45-4.49 mIU/L), SHyper (TSH < 0.45 mIU/L) and subclinical hypothyroidism (SHypo, TSH ≥ 4.50-19.99 mIU/L) both with normal free thyroxine levels. Our primary outcome was annualized percentage BMD change (%ΔBMD) from serial dual X-ray absorptiometry scans of the femoral neck, total hip and lumbar spine, obtained from multivariable regression in a random-effects two-step approach. RESULTS Amongst 5458 individuals (median age 72 years, 49.1% women) from six prospective cohorts, 451 (8.3%) had SHypo and 284 (5.2%) had SHyper. During 36 569 person-years of follow-up, those with SHyper had a greater annual bone loss at the femoral neck versus euthyroidism: %ΔBMD = -0.18 (95% CI: -0.34, -0.02; I2 = 0%), with a nonstatistically significant pattern at the total hip: %ΔBMD = -0.14 (95% CI: -0.38, 0.10; I2 = 53%), but not at the lumbar spine: %ΔBMD = 0.03 (95% CI: -0.30, 0.36; I2 = 25%); especially participants with TSH < 0.10 mIU/L showed an increased bone loss in the femoral neck (%Δ BMD = -0.59; [95% CI: -0.99, -0.19]) and total hip region (%ΔBMD = -0.46 [95% CI: -1.05, -0.13]). In contrast, SHypo was not associated with bone loss at any site. CONCLUSION Amongst adults, SHyper was associated with increased femoral neck bone loss, potentially contributing to the increased fracture risk.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Segna, Daniel; Feller, Martin; Schneider, Claudio; Aubert, Carole Elodie; Da Costa, Bruno; Blum, Manuel; van Dorland, Hendrika Anette; Aujesky, Drahomir and Rodondi, Nicolas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0954-6820

Publisher:

Blackwell Scientific Publications

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

11 Jan 2018 12:44

Last Modified:

17 Jan 2019 12:26

Publisher DOI:

10.1111/joim.12688

PubMed ID:

29034571

Uncontrolled Keywords:

bone density bone loss hyperthyroidism hypothyroidism prospective studies thyroid disease

BORIS DOI:

10.7892/boris.108951

URI:

https://boris.unibe.ch/id/eprint/108951

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