Serum TSH values and risk of vertebral fractures in euthyroid post-menopausal women with low bone mineral density
Abstract
Introduction There is evidence that variations of thyrotropin (TSH) even in its reference range may influence bone mineral density (BMD). In fact, low-normal TSH values have been associated with high prevalence of osteoporosis in post-menopausal women. However, data associating TSH and risk of fractures are scanty and limited to subjects with subclinical thyrotoxicosis.Materials and methods In this observational study, we investigated the correlation between serum TSH and prevalence of radiological vertebral fractures in a cohort of 130 post-menopausal women with normal thyroid function.Results Osteoporosis was observed in 80 women (61.5%), whereas 49 women (37.7%) had osteopenia. Vertebral fractures were found in 49 women (37.7%), who were significantly older, with higher prevalence of osteoporosis and with lower serum TSH values as compared with women who did not fracture. Stratifying the patients according to serum TSH values, vertebral fractures were found to be significantly (p=0.004) more prevalent in first tertile (56.8%) of TSH values as compared with the second (23.3%) and third tertiles (32.6%). Multivariate logistic regression analysis demonstrated that low serum TSH maintained a significant correlation with vertebral fractures (odds ratio 2.8, C.I. 95% 1.20-6.79) even after correction for age, BMD, BMI and serum free-thyroxine values.Discussion Low-normal TSH values are associated with high prevalence of vertebral fractures in women with post-menopausal osteoporosis or osteopenia, independently of thyroid hormones, age and BMD.
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Variation in thyroid status within the reference range in post-menopausal women is associated with altered bone mineral density and fracture risk.
“Population studies have also shown that variation in thyroid status within the reference range in post-menopausal women is associated with altered BMD and fracture risk.”
From Thyroid diseases and bone health (2018) · cites this paper as [45]
The risk of vertebral fractures in older adults is increased with serum thyroid stimulating hormone use in the lower range of normal limits.
“Recently it has been shown that the risk of vertebral fractures in older adults is increased with serum thyroid stimulating hormone use in the lower range of normal limits.63”
From Levothyroxine dose and risk of fractures in older adults: nested case-control study (2011) · cites this paper as [63]
Such an association was shown to be independent of thyroid hormone values.
“Such an association was shown to be independent of thyroid hormone values.”
From Pituitary Diseases and Bone (2018) · cites this paper as [270]
Lower TSH levels and higher levels of FT4 within the population reference-range are associated with increased risk of developing osteoporosis and suffering subsequent fractures in post-menopausal women.
“Similar cross-sectional analyses have identified that lower TSH levels and higher levels of FT4 within the population reference-range are associated with increased risk of developing osteoporosis [70–73] and suffering subsequent fractures [71, 74] in post-menopausal women.”
From Age-related variation in thyroid function – a narrative review highlighting important implications for research and clinical practice (2023) · cites this paper as [74]
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References 35 · Cited by 113
- Authors
- Mazziotti, G., Porcelli, T., Patelli, I., Vescovi, P. P., & Giustina, A.
- Affiliations
- Azienda Ospedaliera Carlo Poma (IT)
- University of Brescia (IT)
- Corresponding author
- Giustina, Andrea
- Venue
- Bone
- Publisher
- Elsevier BV
- Published
- 2010-03
- Volume
- 46
- Issue
- 3
- Pages
- 747-751
- ISSN
- 1873-2763 (ISSN-L)
- 8756-3282
- OpenAlex
- W2163537687
- Cited by
- 113
- References
- 35
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 11 · 2022: 5 · 2021: 4 · 2020: 4 · 2019: 3 · 2018: 8 · 2017: 11 · 2016: 9 · 2015: 6 · 2014: 9 · 2013: 7 · 2012: 14
- FWCI
- 9.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Bone (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- 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 › Menopause: Health Impacts and Treatments
- Keywords
- thyroid-stimulating hormone, vertebral fractures, postmenopausal women, osteopenia, osteoporosis, thyroid function, fracture risk, subclinical hypothyroidism
- MeSH terms
- Aged, Aged, 80 and over, Euthyroid Sick Syndromes, Female, Humans, Lumbar Vertebrae, Middle Aged, Radiography, Thyrotropin, Cohort Studies, Biomarkers, Bone Density, Osteoporosis, Postmenopausal, Spinal Fractures, Postmenopause
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