A prospective study of thyroid function, bone loss, and fractures in older men: The MrOS study
Open accessAbstract
Excess thyroid hormone is associated with increased bone loss and fracture risk in older women, but few data exist for men. We sought to determine if thyroid function is independently associated with bone loss and fracture risk in older men. Data were analyzed from the Osteoporotic Fractures in Men (MrOS) study, a cohort of community-dwelling U.S. men aged 65 years and older. Using a case-cohort design, fasting baseline serum archived at -80°C was assayed for thyroid-stimulating hormone (thyrotropin) (TSH) and free thyroxine (FT4) in 397 men with confirmed nonspine fracture, including 157 hip fractures, and 1420 randomly selected men without fracture. TSH and FT4 were analyzed as continuous variables and as thyroid function categories (subclinical hyperthyroid, euthyroid, and subclinical hypothyroid). Hip dual-energy X-ray absorptiometry (DXA) (Hologic QDR4500) was measured at baseline and after a mean follow-up of 4.6 years. Incident nonspine fractures were centrally adjudicated. Bone loss was evaluated with multivariate regression methods and fractures risk was evaluated using hazard models that accounted for the case-cohort sampling, adjusted for age, clinic-site, body mass index (BMI), race, physical activity, corticosteroid use, smoking, alcohol intake, and thyroid medication use. In fully adjusted analyses, TSH was not associated with risk of nonspine fracture (relative hazard [RH] 0.92 per SD decrease in TSH; 95% confidence interval [CI], 0.74-1.14), but was significantly associated with risk of hip fracture (RH 1.31; 95% CI, 1.01-1.71), which persisted among normal range TSH values (RH 1.21; 95% CI, 1.00-1.47). There was no association between TSH or FT4 and bone loss, and fracture risk did not differ significantly by thyroid function category. We conclude that although neither TSH nor FT4 are associated with bone loss, lower serum TSH may be associated with an increased risk of hip fractures in older men.
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The findings were broadly similar to the MrOS cohort, where fracture risk related to each SD decrease in baseline TSH rather than sequential TSH.
“and also broadly similar to the findings in the MrOS (28) cohort, in which fracture risk was related to each SD decrease in TSH at baseline rather than based on sequential TSH assessments.”
Other studies have not found increased fracture rates in SH subjects.
“Other studies have not found increased fracture rates in SH subjects (410-412).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [412]
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- Authors
- Waring, A. C., Harrison, S., Fink, H. A., Samuels, M. H., Cawthon, P. M., Zmuda, J. M., Orwoll, E. S., Bauer, D. C., & Study, F. T. O. F. I. M. (.
- Affiliations
- University of California, San Francisco (US)
- California Pacific Medical Center (US)
- University of Minnesota (US)
- Oregon Health & Science University (US)
- University of Pittsburgh (US)
- Corresponding author
- Bauer, Douglas C
- ORCID
- Venue
- Journal of Bone and Mineral Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-09-27
- Volume
- 28
- Issue
- 3
- Pages
- 472-479
- ISSN
- 0884-0431 (ISSN-L)
- 1523-4681
- PMC
- PMC4095773
- OpenAlex
- W1996440373
- Cited by
- 68
- References
- 41
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 6 · 2023: 4 · 2022: 5 · 2021: 3 · 2020: 9 · 2019: 4 · 2018: 5 · 2017: 8 · 2016: 4 · 2015: 6 · 2014: 7 · 2013: 2
- FWCI
- 5.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Journal of Bone and Mineral Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (RR024140)
- National Institute on Aging (U01AG018197, U01AG027810, AG027810)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (U01AR045583, U01AR045580, U01AR045632, U01AR045654, U01AR045614, U01AR045647, K24AR051895)
- National Center for Research Resources (UL1RR024140)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- thyroid function, thyroid-stimulating hormone, free thyroxine, subclinical hyperthyroidism, subclinical hypothyroidism, bone loss, hip fracture, older men, osteoporosis, fracture risk
- MeSH terms
- Aged, Humans, Male, Osteoporosis, Prospective Studies, Thyroid Function Tests, Thyroid Hormones, Absorptiometry, Photon, Fractures, Bone
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