Jennifer S. Lee, MD, PhD; Petra B ková, PhD; Howard A. Fink, MD, MPH; Joseph Vu,
MD; Laura Carbone, MD, MS; Zhao Chen, PhD; Jane Cauley, DrPH; Doug C. Bauer, MD; Anne R. Cappola, MD, ScM; John Robbins, MD Arch Intern Med. 2010;170(21):1876-1883. doi:10.1001/archinternmed.2010.424

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 men-years) 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.

Conteúdo enviado por: Achilles Cruz