Available online 11 March 2023
Author links open overlay panel, , , , , , , ABSTRACTBackgroundThyroid dysfunction and osteoporosis are conditions strongly associated with aging, and the prevalence of both conditions is expected to increase in the coming decades. Thyroid hormones regulate bone metabolism, and the role of subclinical hypothyroidism on bone mineral density (BMD) is still controversial. Hence, this study aims to assess the association of subclinical hypothyroidism with femoral osteopenia and osteoporosis in individuals aged 50 years or older.
MethodologyThis retrospective cohort study was carried out with 864 outpatients having at least one result for TSH levels before the first record of dual-energy X-ray absorptiometry (DXA). The primary endpoints were osteopenia (-2.5 standard deviation (SD) <T-score <-1.0SD) and osteoporosis (T-score ≤-2.5SD). Cox proportional hazards regression assessed the association of subclinical hypothyroidism (TSH ≥4.5 mIU/L) with osteopenia and osteoporosis in unadjusted and covariate-adjusted models. Hazard ratios (HR) and 95% confidence intervals (95%CI) were calculated, and p-values <0.05 were considered statistically significant.
ResultsThere was no significant association between subclinical hypothyroidism and femoral osteopenia in either unadjusted [HR: 1.149 (0.835-1.580); p=0.394] or fully covariate-adjusted models [HR: 1.069 (0.774-1.477); p=0.687]. Subclinical hypothyroidism was associated with femoral osteoporosis in the unadjusted analysis [HR: 1.981 (1.044-3.757); p= 0.036], but a lack of association occurred and remained after successive covariate-adjustments analyses [HR: 1.392 (0.615-3.152); p=0.428].
ConclusionSubclinical hypothyroidism is not independently associated with either femoral osteopenia or osteoporosis in individuals aged 50 years or older over a four-year follow-up time.
Section snippetsINTRODUCTIONThyroid dysfunction and osteoporosis are common conditions in the elderly, and the prevalence of both conditions increases with aging1,2. The progressive decline in the birth rate combined with the increase in life expectancy has resulted in rapid population aging, giving rise to a new global demographic profile. The population stratum aged 65 years or older has increased from 6 to 9% between 1990 and 2019, and it is estimated to reach 17% in the next three decades, corresponding to 1.5 billion
Study design and participantsThis single-center retrospective cohort study was conducted to assess the association of subclinical hypothyroidism with femoral osteopenia and osteoporosis. The initial participant cohort was carefully screened for inclusion and exclusion criteria between February 2010 and July 2021 at the Military Hospital in Brasília, Brazil. Participants were included if they: (i) were outpatients aged 50 years or older undergoing check-up examinations; (ii) have records of thyroid function tests (TFT)
Study populationA total of 864 participants without overt thyroid dysfunction aged 50 years or older with TSH levels measured before the first record of DXA was identified. Participants were stratified into three subgroups according to femoral T-scores: normal, osteopenia, and osteoporosis. Their clinical and biochemical characteristics were compared, as shown in Table 1.
Participants with femoral osteoporosis were older than those with femoral osteopenia and normal T-scores. Also, they had a higher 10-year
DISCUSSIONTo the best of our knowledge, we present the first longitudinal study to date assessing the association of subclinical hypothyroidism with either femoral osteopenia or osteoporosis over a follow-up time of 4 years. We conducted this research aiming to determine whether subclinical hypothyroidism diagnosed before densitometric findings could be associated or not with the decline of femoral bone mass. In addition, clinical predictors of femoral osteopenia and osteoporosis were identified in our
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