Subclinical Thyroid Dysfunction and Incident Hip Fracture in Older Adults
Open accessAbstract
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.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In a prospective cohort study of 5,567 US community-dwelling adults aged 65 years or older followed for a median of 13 years, the incidence of hip fracture was higher in elderly men with SHyper than in euthyroid controls (HR = 4.91; 95% CI 1.13-21.27).
“In a prospective cohort study of US community-dwelling adults (5,567 individuals 65 years or older followed for a median of 13 years), the incidence of hip fracture was higher in elderly men with SHyper than in euthyroid controls (HR = 4.91; 95% CI: 1.13-21.27),with no clear association in women [106] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [106]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredOlder adults are more vulnerable to excessive levothyroxine replacement.
“Our study specifically focused on older adults, who have a higher baseline risk of fracture15 26 56 and are more vulnerable to excessive levothyroxine replacement.11 12 13 14”
From Levothyroxine dose and risk of fractures in older adults: nested case-control study (2011) · cites this paper as [13]
The COMMENT section (page unavailable in our copy) reports increased hip-fracture risk in older men with subclinical thyroid dysfunction and says the risk did not clearly depend on whether the dysfunction was endogenous or exogenous. This supports concern about excess thyroid hormone in older men, but the paper does not specifically establish that older adults are more vulnerable than younger adults to excessive levothyroxine replacement; it found no clear fracture association in older women. (LLM, conf=0.83)
Experimental — accuracy not yet measuredConflicting results have been reported regarding the risk of fractures in SHyper.
“Conflicting results have also been reported regarding the risk of fractures [63,105,106] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [106]
In that prospective cohort study, there was no clear association between SHyper and hip fracture in women.
“In a prospective cohort study of US community-dwelling adults (5,567 individuals 65 years or older followed for a median of 13 years), the incidence of hip fracture was higher in elderly men with SHyper than in euthyroid controls (HR = 4.91; 95% CI: 1.13-21.27),with no clear association in women [106] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [106]
Increased bone loss and risk of fracture are found in euthyroid postmenopausal women with fT4 and/or fT3 levels within the upper normal range and in older adults with low TSH.
“Increased bone loss and risk of fracture was also found in euthyroid postmenopausal women with fT4 and/or fT3 levels within the upper normal range and in older adults with low TSH (104–106).”
From Levothyroxine therapy in elderly patients with hypothyroidism (2021) · cites this paper as [106]
Taken together, the evidence suggests patients with hypothyroidism as a group may not have a clinically relevant increased osteoporotic fracture risk.
“Taken together, the evidence base suggests that patients with hypothyroidism as a group may not be at a clinically relevant increased risk of osteoporotic fractures.”
A prospective US study confirmed increased hip fracture risk in male but not female patients.
“which was since confirmed in a prospective study in the United States, which also found increased hip fracture risk in the male but not the female patients.(18)”
Observational studies in the United Kingdom and the United States reported an increased fracture risk in men but not women treated for hypothyroidism.
“An increased risk in men but not women treated for hypothyroidism was also reported from observational studies in both the United Kingdom (17) and the United States.(18)”
A number of population-based studies have reported that certain groups of subjects with SH have increased fracture rates, including all adults, postmenopausal women, men, or subjects who progress to overt hyperthyroidism over time.
“A number of population-based studies have reported that certain groups of subjects with SH have increased fracture rates, including all adults (407), postmenopausal women (408), men (409), or subjects who progress to overt hyperthyroidism over time (391).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [409]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 38 · Cited by 134
- Authors
- Lee, J. S., Bůžková, P., Fink, H. A., Vu, J., Carbone, L., Chen, Z., Cauley, J., Bauer, D. C., Cappola, A. R., & Robbins, J.
- Affiliations
- University of California, Davis (US)
- University of Minnesota (US)
- ORCID
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2010-11-22
- Volume
- 170
- Issue
- 21
- Pages
- 1876-83
- ISSN
- 0003-9926 (ISSN-L)
- PMC
- PMC4122328
- OpenAlex
- W2035512160
- Cited by
- 134
- References
- 38
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 4 · 2023: 2 · 2022: 4 · 2021: 7 · 2020: 8 · 2019: 12 · 2018: 6 · 2017: 13 · 2016: 7 · 2015: 13 · 2014: 18 · 2013: 12 · 2012: 17
- FWCI
- 8.68
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- D-Scholarship@Pitt (University of Pittsburgh) (acceptedVersion)
- Funders
- National Institutes of Health (n01hc085082-026, n01hc085081-021, n01hc085079-024, n01hc015103-009, n01hc085084-005, n01hc085085-011, n01hc085083-027, n01hc085080-026, n01hc085086-022, n01hc55222-0-0-0, n01hc075150-004, n01hc035129-010)
- National Heart, Lung, and Blood Institute (N01-HC-85081, N01HC85085, N01 HC085086, N01HC-85083, N01 HC085079, N01HC85082, N01HC‐75150, N01 HC85086, N01 HC035129, N01HC85080, N01 HC015103, N01 HC55222, U01HL080295, N01 HC055222, N01 HC075150, N01-HC85079, N01-HC85084)
- National Center for Research Resources (UL1RR024146)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- subclinical thyroid dysfunction, subclinical hyperthyroidism, subclinical hypothyroidism, hip fracture, fracture risk, older adults, sex differences, bone metabolism, community-dwelling adults, euthyroidism, menopause, hormone replacement therapy, estradiol, bone mineral density, bone turnover markers
- MeSH terms
- Aged, Female, Follow-Up Studies, Hip Fractures, Humans, Hyperthyroidism, Hypothyroidism, Male, Prospective Studies, Risk Factors, Thyrotropin, United States, Incidence, Multivariate Analysis, Proportional Hazards Models, Sex Distribution
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
