Thyroid function tests in the reference range and fracture: individual participant analysis of prospective cohorts

Aubert, C. E. et al. (2017) Thyroid function tests in the reference range and fracture: individual participant analysis of prospective cohorts. Journal of Clinical Endocrinology and Metabolism, 102(8), pp. 2719-2728. (doi: 10.1210/jc.2017-00294) (PMID:28482002)

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Hyperthyroidism is associated with increased fracture risk, but it is not clear if lower TSH and higher free thyroxine (FT4) in euthyroid individuals are associated with fracture risk. To evaluate the association of TSH and FT4 with incident fractures in euthyroid individuals. Individual participant data analysis. Thirteen prospective cohort studies with baseline examinations between 1981 and 2002. Adults with baseline TSH 0.45-4.49 mIU/L. Primary outcome was incident hip fracture. Secondary outcomes were any, non-vertebral, and vertebral fractures. Results were presented as hazard ratios (HR) with 95% confidence interval (CI) adjusted for age and sex. For clinical relevance, we studied TSH according to five categories: 0.45-0.99mIU/L; 1.00-1.49mIU/L; 1.50-2.49mIU/L; 2.50-3.49mIU/L; 3.50-4.49mIU/L (reference). FT4 was assessed as study-specific standard deviation increase, because assays varied between cohorts. During 659,059 person-years, 2,565/56,835 participants had hip fracture (4.5%; 12 studies with data on hip fracture). The pooled adjusted HR (95% CI) for hip fracture was 1.25 (1.05-1.49) for TSH 0.45-0.99mIU/L, 1.19 (1.01-1.41) for TSH 1.00-1.49mIU/L, 1.09 (0.93-1.28) for TSH 1.50-2.49mIU/L, and 1.12 (0.94-1.33) for TSH 2.50-3.49mIU/L (P for trend = 0.004). Hip fracture was also associated with FT4 (HR [95%CI] 1.22 [1.11-1.35] per one standard deviation increase in FT4). FT4 only was associated with any and non-vertebral fracture. Results remained similar in sensitivity analyses. Among euthyroid adults, lower TSH and higher FT4 are associated with an increased risk of hip fracture. These findings may help refine the definition of optimal ranges of thyroid function tests.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Stott J, Professor David
Authors: Aubert, C. E., Floriani, C., Bauer, D. C., da Costa, B. R., Segna, D., Blum, M. R., Collet, T.-H., Fink, H. A., Cappola, A. R., Syrogiannouli, L., Peeters, R. P., Åsvold, B. O., den Elzen, W. P., Luben, R. N., Bremner, A. P., Gogakos, A., Eastell, R., Kearney, P. M., Hoff, M., Le Blanc, E., Ceresini, G., Rivadeneira, F., Uitterlinden, A. G., Khaw, K.-T., Langhammer, A., Stott, D. J., Westendorp, R. G., Ferrucci, L., Williams, G. R., Gussekloo, J., Walsh, J. P., Aujesky, D., and Rodondi, N.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Journal of Clinical Endocrinology and Metabolism
Publisher:Oxford University Press
ISSN (Online):1945-7197
Published Online:05 May 2017
Copyright Holders:Copyright © 2017 Endocrine Society
First Published:First published in Journal of Clinical Endocrinology and Metabolism 102(8):2719-2728
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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