绝经后女性促甲状腺激素水平与骨质疏松性骨折的相关性研究
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摘要
目的探讨绝经后女性血清促甲状腺激素水平与骨质疏松性骨折的相关性。方法 2011年5月至2011年10月期间对贵阳市云岩区4 073名40岁及以上居民开展问卷调查、体格检查、促甲状腺激素(thyroid stimulating hormone,TSH)检验及跟骨超声骨密度测定等。根据基线TSH水平,将调查对象分为3组,分别是TSH降低组(TSH<0.55 mIU/L,71人)、TSH正常组(0.55 mIU/L≤TSH≤4.78 mIU/L,3 113人)、TSH升高组(TSH>4.78 mIU/L,889人),比较各组基线特征。随访3年后,根据随访期内是否发生骨折分析不同TSH水平与骨质疏松性骨折的相关性。结果 TSH降低组、TSH正常组、TSH升高组中新发骨质疏松性骨折的人数分别为8例、51例、148例,发病率分别为11.3%、4.8%、5.7%,TSH降低组骨折发病率高于TSH正常组,差异具有统计学意义(P=0.012)。TSH升高组较正常组相比差异无统计学意义。②骨密度T值≤-2.5[OR=1.822,95%CI(1.124,2.954),P=0.004]、血脂异常[OR=1.381,95%CI(1.038,1.836),P<0.05]、TSH<0.55 mIU/L[OR=2.469,95%CI(1.163,5.243),P<0.05]是骨质疏松性骨折的危险因素,校正血脂异常、骨密度T值≤-2.5后,TSH降低组与TSH正常组相比,骨折风险增加2.626倍[OR=2.626,95%CI(1.233,5.592),P<0.05]。结论绝经后女性TSH水平降低与骨质疏松性骨折风险增加相关。
Objective To investigate the correlation between serum thyroid stimulating hormone and osteoporotic fracture in postmenopausal women. Methods A total of4073 residents aged over 40 years old from Yunyan District, Guiyang City were investigated with questionnaire, physical examination, determination of serum TSH, and ultrasonic bone mineral density measurement of the calcaneus. According to the baseline TSH level, the subjects were divided into three groups: low(TSH<0.55 mIU/L, n=71), normal(0.55 mIU/L ≤ TSH ≤ 4.78 mIU/L, n=3113), or high(TSH>4.780 mIU/L, n=889). The baseline characteristics of each group were compared. After 3 years of follow-up, the correlation between different TSH levels and osteoporotic fractures was analyzed according to whether fractures occurred during the follow-up period. Results The number of newly developed osteoporosis fractures in the lower TSH group, the normal TSH group, and the higher TSH group were 8, 148, 51, respectively. The incidence was 11.3%, 4.8%, and 5.7%, respectively. The incidence of fracture in the lower TSH group was higher than that in normal TSH group(P<0.17). In addition, BMD T-score≤-2.5(OR=1.822, 95%CI 1.124-2.954, P=0.004), dyslipidemia(OR=1.381, 95%CI 1.038-1.836, P=0.034), TSH<0.55 mIU/L(OR=2.469, 95%CI 1.163-5.243, P=0.019) were risk factors of osteoporotic fracture. Compared with that in the normal TSH group, the risk of fracture in the lower TSH group was increased by 2.626 times(OR=2.626, 95%CI 1.233-5.592, P=0.012) after adjusting dyslipidemia and BMD T-score≤-2.5. Conclusion Lower TSH levels are associated with an increased risk of osteoporotic fracture in postmenopausal women.
Objective To investigate the correlation between serum thyroid stimulating hormone and osteoporotic fracture in postmenopausal women. Methods A total of4073 residents aged over 40 years old from Yunyan District, Guiyang City were investigated with questionnaire, physical examination, determination of serum TSH, and ultrasonic bone mineral density measurement of the calcaneus. According to the baseline TSH level, the subjects were divided into three groups: low(TSH<0.55 mIU/L, n=71), normal(0.55 mIU/L ≤ TSH ≤ 4.78 mIU/L, n=3113), or high(TSH>4.780 mIU/L, n=889). The baseline characteristics of each group were compared. After 3 years of follow-up, the correlation between different TSH levels and osteoporotic fractures was analyzed according to whether fractures occurred during the follow-up period. Results The number of newly developed osteoporosis fractures in the lower TSH group, the normal TSH group, and the higher TSH group were 8, 148, 51, respectively. The incidence was 11.3%, 4.8%, and 5.7%, respectively. The incidence of fracture in the lower TSH group was higher than that in normal TSH group(P<0.17). In addition, BMD T-score≤-2.5(OR=1.822, 95%CI 1.124-2.954, P=0.004), dyslipidemia(OR=1.381, 95%CI 1.038-1.836, P=0.034), TSH<0.55 mIU/L(OR=2.469, 95%CI 1.163-5.243, P=0.019) were risk factors of osteoporotic fracture. Compared with that in the normal TSH group, the risk of fracture in the lower TSH group was increased by 2.626 times(OR=2.626, 95%CI 1.233-5.592, P=0.012) after adjusting dyslipidemia and BMD T-score≤-2.5. Conclusion Lower TSH levels are associated with an increased risk of osteoporotic fracture in postmenopausal women.
引文
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[15] Cui LH,Shin MH,Chung EK,et al.Association between bone mineral densities and serum lipid profiles of pre- and post-menopausal rural women in South Korea[J].Osteoporosis International,2005,16(12):1975-1981.
[16] Pliatsika P,Antoniou A,Alexandrou A,et al.Serum lipid levels and bone mineral density in Greek postmenopausal women[J].Gynecological Endocrinology,2012,28(8):655-660.
[17] Nicholls JJ,Brassill MJ,Williams GR,et al.The skeletal consequences of thyrotoxicosis[J].Journal of Endocrinology,2012,213(3):209-221.
[18] Blum MR,Bauer DC,Collet TH,et al.Subclinical thyroid dysfunction and fracture risk:a meta-analysis[J].JAMA,2015,313(20):2055-2065.
[19] Vestergaard P,Mosekilde L.Hyperthyroidism,bone mineral,and fracture risk--a meta-analysis[J].Thyroid,2003,13(6):585-593.
[20] Li S,Davies TF,Blair HC,et al.TSH and bone loss[J].Annals of the New York Academy of Sciences,2006,1068(1):309-318.
[21] Mazziotti G,Porcelli T,Patelli I,et al.Serum TSH values and risk of vertebral fractures in euthyroid post-menopausal women with low bone mineral density[J].Bone,2010,46(3):747-751.
[22] Leader A,Ayzenfeld RH,Lishner M,et al.Thyrotropin levels within the lower normal range are associated with an increased risk of hip fractures in euthyroid women,but not men,over the age of 65 years[J].J Clin Endocrinol Metab,2014,99(8):2665-2673.
[23] Bauer DC,Ettinger B,Nevitt MC,et al.Risk for Fracture in Women with Low Serum Levels of Thyroid-Stimulating Hormone[J].Annals of Internal Medicine,2001,134(7):561-568.
[24] Flynn RW,Bonellie SR,Jung RT,et al.Serum thyroid-stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy[J].Journal of Clinical Endocrinology & Metabolism,2010,95(1):186-193.
[25] Wartofsky L.Subclinical hyperthyroidism and fracture risk in women[J].J Clin Endocrinol Metab,2014,99(8):2654-2656.
[26] Abe E,Marians RC,Yu W,et al.TSH Is a Negative Regulator of Skeletal Remodeling[J].Cell,2003,115(2):151-162.
[27] Baliram R,Latif R,Berkowitz J,et al.Thyroid-stimulating hormone induces a Wnt-dependent,feed-forward loop for osteoblastogenesis in embryonic stem cell cultures[J].Proceedings of the National Academy of Sciences of the United States of America,2011,108(39):16277-16282.
[28] Baliram R,Sun L,Cao J,et al.Hyperthyroid-associated osteoporosis is exacerbated by the loss of TSH signaling[J].Journal of Clinical Investigation,2012,122(10):3737-3741.
[2] Lin X,Xiong D,Peng YQ,et al.Epidemiology and management of osteoporosis in the People’s Republic of China:current perspectives[J].Clinical Interventions in Aging,2015(10):1017-1033.
[3] Cardoso LF,Maciel LM,de Paula FJ.The multiple effects of thyroid disorders on bone and mineral metabolism[J].Arquivos Brasileiros De Endocrinologia E Metabologia,2014,58(5):452-463.
[4] Hadidy EHME,Ghonaim M,Gawad SSAE,et al.Impact of severity,duration,and etiology of hyperthyroidism on bone turnover markers and bone mineral density in men[J].Bmc Endocrine Disorders,2011,11(1):1-7.
[5] Lee JS,Fink HA,Vu J,et al.Subclinical Thyroid Dysfunction and Incident Hip Fracture in Older Adults[J].Archives of Internal Medicine,2010,170(21):1876-1883.
[6] Vadiveloo T,Donnan PT,Cochrane L,et al.The Thyroid Epidemiology,Audit,and Research Study (TEARS):morbidity in patients with endogenous subclinical hyperthyroidism[J].Journal of Clinical Endocrinology & Metabolism,2010,11(6):284-284.
[7] Garin MC,Al E.Subclinical thyroid dysfunction and hip fracture and bone mineral density in older adults:the cardiovascular health study[J].Journal of Clinical Endocrinology & Metabolism,2014,99(8):2657-2664.
[8] Svare A,Nilsen TI,Asvold BO,et al.Does thyroid function influence fracture risk?Prospective data from the HUNT2 study,Norway[J].European Journal of Endocrinology,2013,169(6):845-852.
[9] 樊萌语,吕筠,何平平.国际体力活动问卷中体力活动水平的计算方法[J].中华流行病学杂志,2014,35(8):961-964.
[10] 中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊疗指南(2017)[J].中华骨质疏松和骨矿盐疾病杂志,2017,20(5):413-443.
[11] 《中国成人血脂异常防治指南》制定联合委员会.中国成人血脂异常防治指南[J].中华心血管病杂志,2007,35(5):1-30.
[12] 张巧,时立新,彭年春,等.贵阳城区糖尿病、糖尿病前期流行病学调查及危险因素分析[J].中华内分泌代谢杂志,2013,29(2):144-147.
[13] Trimpou P,Bosaeus I,Bengtsson BA,et al.High correlation between quantitative ultrasound and DXA during 7 years of follow-up[J].European Journal of Radiology,2010,73(2):360-364.
[14] Moayyeri A,Adams JE,Adler RA,et al.Quantitative ultrasound of the heel and fracture risk assessment:an updated meta-analysis[J].Osteoporosis International,2012,23(1):143-153.
[15] Cui LH,Shin MH,Chung EK,et al.Association between bone mineral densities and serum lipid profiles of pre- and post-menopausal rural women in South Korea[J].Osteoporosis International,2005,16(12):1975-1981.
[16] Pliatsika P,Antoniou A,Alexandrou A,et al.Serum lipid levels and bone mineral density in Greek postmenopausal women[J].Gynecological Endocrinology,2012,28(8):655-660.
[17] Nicholls JJ,Brassill MJ,Williams GR,et al.The skeletal consequences of thyrotoxicosis[J].Journal of Endocrinology,2012,213(3):209-221.
[18] Blum MR,Bauer DC,Collet TH,et al.Subclinical thyroid dysfunction and fracture risk:a meta-analysis[J].JAMA,2015,313(20):2055-2065.
[19] Vestergaard P,Mosekilde L.Hyperthyroidism,bone mineral,and fracture risk--a meta-analysis[J].Thyroid,2003,13(6):585-593.
[20] Li S,Davies TF,Blair HC,et al.TSH and bone loss[J].Annals of the New York Academy of Sciences,2006,1068(1):309-318.
[21] Mazziotti G,Porcelli T,Patelli I,et al.Serum TSH values and risk of vertebral fractures in euthyroid post-menopausal women with low bone mineral density[J].Bone,2010,46(3):747-751.
[22] Leader A,Ayzenfeld RH,Lishner M,et al.Thyrotropin levels within the lower normal range are associated with an increased risk of hip fractures in euthyroid women,but not men,over the age of 65 years[J].J Clin Endocrinol Metab,2014,99(8):2665-2673.
[23] Bauer DC,Ettinger B,Nevitt MC,et al.Risk for Fracture in Women with Low Serum Levels of Thyroid-Stimulating Hormone[J].Annals of Internal Medicine,2001,134(7):561-568.
[24] Flynn RW,Bonellie SR,Jung RT,et al.Serum thyroid-stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy[J].Journal of Clinical Endocrinology & Metabolism,2010,95(1):186-193.
[25] Wartofsky L.Subclinical hyperthyroidism and fracture risk in women[J].J Clin Endocrinol Metab,2014,99(8):2654-2656.
[26] Abe E,Marians RC,Yu W,et al.TSH Is a Negative Regulator of Skeletal Remodeling[J].Cell,2003,115(2):151-162.
[27] Baliram R,Latif R,Berkowitz J,et al.Thyroid-stimulating hormone induces a Wnt-dependent,feed-forward loop for osteoblastogenesis in embryonic stem cell cultures[J].Proceedings of the National Academy of Sciences of the United States of America,2011,108(39):16277-16282.
[28] Baliram R,Sun L,Cao J,et al.Hyperthyroid-associated osteoporosis is exacerbated by the loss of TSH signaling[J].Journal of Clinical Investigation,2012,122(10):3737-3741.