Subclinical thyroid dysfunction and incident hip fracture in older adults

Jennifer S. Lee, Petra Bůžková, Howard A. Fink, Joseph Vu, Laura D Carbone, Zhao Chen, Jane Cauley, Doug C. Bauer, Anne R. Cappola, John Robbins

Research output: Contribution to journalArticle

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Abstract

Background: Subclinical thyroid dysfunction is common in older adults and affects bone metabolism, but its effects on fracture risk have not been reported. We sought to determine prospectively whether older men and women with subclinical hyperthyroidism or hypothyroidism have an increased risk of hip fracture. Methods: Prospective cohort of 3567 US community-dwelling adults, 65 years or older, with biochemically defined subclinical thyroid dysfunction or euthyroidism was enrolled from June 10, 1989, through May 30, 1990, and followed up through 2004. Main outcome measures included incidence and hazard ratios (HRs), with 95% confidence intervals (CIs), of confirmed incident hip fractures for groups with subclinical hypothyroidism, subclinical hyperthyroidism, and euthyroidism as defined at baseline. Results: During 39 952 person-years (median follow-up, 13 years), hip fracture incidence (per 1000 menyears) was 13.65 in men with subclinical hyperthyroidism (n = 29) and 10.27 in men with subclinical hypothyroidism (n = 184), both greater than 5.0 in men with euthyroidism (n = 1159). Men with subclinical hypothyroidism had a multivariable-adjusted HR of 2.31 (95% CI, 1.25-4.27); those with subclinical hyperthyroidism, 3.27 (0.99-11.30). After excluding those with baseline use of thyroid-altering medications, men with endogenous subclinical hyperthyroidism had a higher HR of 4.91 (95% CI, 1.13-21.27), as did men with endogenous subclinical hypothyroidism (2.45, 1.27-4.73). Hip fracture incidence (per 1000 women-years) was 8.93 in women with subclinical hypothyroidism (n = 359) and 10.90 in women with subclinical hyperthyroidism (n = 142) compared with 10.18 in women with euthyroidism (n = 1694). No clear association between subclinical dysfunction and fracture was observed in women. Conclusions: Older men with subclinical hyperthyroidism or hypothyroidism are at increased risk for hip fracture. Whether treatment of the subclinical syndrome reduces this risk is unknown.

Original languageEnglish (US)
Pages (from-to)1876-1883
Number of pages8
JournalArchives of Internal Medicine
Volume170
Issue number21
DOIs
StatePublished - Nov 22 2010
Externally publishedYes

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Hip Fractures
Hyperthyroidism
Hypothyroidism
Thyroid Gland
Confidence Intervals
Incidence
Independent Living
Outcome Assessment (Health Care)
Bone and Bones

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Subclinical thyroid dysfunction and incident hip fracture in older adults. / Lee, Jennifer S.; Bůžková, Petra; Fink, Howard A.; Vu, Joseph; Carbone, Laura D; Chen, Zhao; Cauley, Jane; Bauer, Doug C.; Cappola, Anne R.; Robbins, John.

In: Archives of Internal Medicine, Vol. 170, No. 21, 22.11.2010, p. 1876-1883.

Research output: Contribution to journalArticle

Lee, JS, Bůžková, P, Fink, HA, Vu, J, Carbone, LD, Chen, Z, Cauley, J, Bauer, DC, Cappola, AR & Robbins, J 2010, 'Subclinical thyroid dysfunction and incident hip fracture in older adults', Archives of Internal Medicine, vol. 170, no. 21, pp. 1876-1883. https://doi.org/10.1001/archinternmed.2010.424
Lee, Jennifer S. ; Bůžková, Petra ; Fink, Howard A. ; Vu, Joseph ; Carbone, Laura D ; Chen, Zhao ; Cauley, Jane ; Bauer, Doug C. ; Cappola, Anne R. ; Robbins, John. / Subclinical thyroid dysfunction and incident hip fracture in older adults. In: Archives of Internal Medicine. 2010 ; Vol. 170, No. 21. pp. 1876-1883.
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abstract = "Background: Subclinical thyroid dysfunction is common in older adults and affects bone metabolism, but its effects on fracture risk have not been reported. We sought to determine prospectively whether older men and women with subclinical hyperthyroidism or hypothyroidism have an increased risk of hip fracture. Methods: Prospective cohort of 3567 US community-dwelling adults, 65 years or older, with biochemically defined subclinical thyroid dysfunction or euthyroidism was enrolled from June 10, 1989, through May 30, 1990, and followed up through 2004. Main outcome measures included incidence and hazard ratios (HRs), with 95{\%} confidence intervals (CIs), of confirmed incident hip fractures for groups with subclinical hypothyroidism, subclinical hyperthyroidism, and euthyroidism as defined at baseline. Results: During 39 952 person-years (median follow-up, 13 years), hip fracture incidence (per 1000 menyears) was 13.65 in men with subclinical hyperthyroidism (n = 29) and 10.27 in men with subclinical hypothyroidism (n = 184), both greater than 5.0 in men with euthyroidism (n = 1159). Men with subclinical hypothyroidism had a multivariable-adjusted HR of 2.31 (95{\%} CI, 1.25-4.27); those with subclinical hyperthyroidism, 3.27 (0.99-11.30). After excluding those with baseline use of thyroid-altering medications, men with endogenous subclinical hyperthyroidism had a higher HR of 4.91 (95{\%} CI, 1.13-21.27), as did men with endogenous subclinical hypothyroidism (2.45, 1.27-4.73). Hip fracture incidence (per 1000 women-years) was 8.93 in women with subclinical hypothyroidism (n = 359) and 10.90 in women with subclinical hyperthyroidism (n = 142) compared with 10.18 in women with euthyroidism (n = 1694). No clear association between subclinical dysfunction and fracture was observed in women. Conclusions: Older men with subclinical hyperthyroidism or hypothyroidism are at increased risk for hip fracture. Whether treatment of the subclinical syndrome reduces this risk is unknown.",
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AU - Bůžková, Petra

AU - Fink, Howard A.

AU - Vu, Joseph

AU - Carbone, Laura D

AU - Chen, Zhao

AU - Cauley, Jane

AU - Bauer, Doug C.

AU - Cappola, Anne R.

AU - Robbins, John

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N2 - Background: Subclinical thyroid dysfunction is common in older adults and affects bone metabolism, but its effects on fracture risk have not been reported. We sought to determine prospectively whether older men and women with subclinical hyperthyroidism or hypothyroidism have an increased risk of hip fracture. Methods: Prospective cohort of 3567 US community-dwelling adults, 65 years or older, with biochemically defined subclinical thyroid dysfunction or euthyroidism was enrolled from June 10, 1989, through May 30, 1990, and followed up through 2004. Main outcome measures included incidence and hazard ratios (HRs), with 95% confidence intervals (CIs), of confirmed incident hip fractures for groups with subclinical hypothyroidism, subclinical hyperthyroidism, and euthyroidism as defined at baseline. Results: During 39 952 person-years (median follow-up, 13 years), hip fracture incidence (per 1000 menyears) was 13.65 in men with subclinical hyperthyroidism (n = 29) and 10.27 in men with subclinical hypothyroidism (n = 184), both greater than 5.0 in men with euthyroidism (n = 1159). Men with subclinical hypothyroidism had a multivariable-adjusted HR of 2.31 (95% CI, 1.25-4.27); those with subclinical hyperthyroidism, 3.27 (0.99-11.30). After excluding those with baseline use of thyroid-altering medications, men with endogenous subclinical hyperthyroidism had a higher HR of 4.91 (95% CI, 1.13-21.27), as did men with endogenous subclinical hypothyroidism (2.45, 1.27-4.73). Hip fracture incidence (per 1000 women-years) was 8.93 in women with subclinical hypothyroidism (n = 359) and 10.90 in women with subclinical hyperthyroidism (n = 142) compared with 10.18 in women with euthyroidism (n = 1694). No clear association between subclinical dysfunction and fracture was observed in women. Conclusions: Older men with subclinical hyperthyroidism or hypothyroidism are at increased risk for hip fracture. Whether treatment of the subclinical syndrome reduces this risk is unknown.

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