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

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