Fractures in Patients with Hyperthyroidism and Hypothyroidism: A Nationwide Follow-Up Study in 16,249 Patients
Abstract
AIM: To study fracture risk in patients with hyperthyroidism and hypothyroidism. SUBJECTS AND METHODS: All patients with hyperthyroidism or autoimmune hypothyroidism diagnosed for the first time between 1983 and 1996 in Denmark were identified through the National Patient Discharge Register. Each patient was compared with three age- and gender-matched controls randomly selected from the general population. Fracture occurrence before and after diagnosis was compared between patients and controls. RESULTS: 11,776 patients with hyperthyroidism (6301 patients with diffuse toxic goiter, mean age, 52.1 +/- 18.6 years, and 5475 with nodular toxic goiter, mean age, 60.4 +/- 15.9 years), and 4473 patients with hypothyroidism (mean age, 66.1 +/- 17.3) were identified. In patients with hyperthyroidism, fracture risk was only significantly increased around the time of diagnosis (incidence rate ratio [IRR] between 1.26 and 2.29), but decreased to normal levels after diagnosis. Surgical treatment of hyperthyroidism was associated with a decreased fracture risk after diagnosis (RR = 0.66, 95% confidence interval [CI]: 0.55-0.78). In hypothyroidism, fracture risk was significantly increased both before and after diagnosis with a peak around the time of diagnosis (IRR between 2.17 and 2.35). CONCLUSIONS: Fracture risk is increased in hyperthyroidism and hypothyroidism. Thyroid surgery seems associated with a decreased fracture risk in hyperthyroid patients.
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Hypothyroidism is linked to increased risk of osteoporosis and fracture.
“Previous studies have indicated that hypothyroidism can be accompanied by decrease of bone mineral density (BMD), osteoporosis, even fracture [7–9].”
From Effects of levothyroxine therapy on bone and mineral metabolism in hypothyroidism: a systematic review and meta-analysis (2025) · cites this paper as [7]
Cites
Risk Factors for Hip Fracture in White Women
Cummings, S. R., Nevitt, M. C., Browner, W. S., Stone, K., Fox, K. M., Ensrud, K. E., Cauley, J., Black, D., & Vogt, T. M. (1995) · New England Journal of Medicine · doi:10.1056/nejm199503233321202 · Cited by 3,595 · see citing works
LAURBERG, P., PEDERSEN, K. M., VESTERGAARD, H., & SIGURDSSON, G. (1991) · Journal of Internal Medicine · doi:10.1111/j.1365-2796.1991.tb00368.x · Cited by 361 · see citing works
Langdahl, B. L., Loft, A. G. R., Eriksen, E. F., Mosekilde, L., & Charles, P. (1996) · European Journal of Endocrinology · doi:10.1530/eje.0.1340702 · Cited by 42 · cited 3× · see citing works
“Accordingly, BMD is usually normal in eu-thyroid patients treated for hypothyroidism (19–21) but may be decreased in the case of suppressed TSH after larger dosages of levothyroxine (22–24).”
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FRAX™ and the assessment of fracture probability in men and women from the UK
Kanis, J. A., Johnell, O., Oden, A., Johansson, H., & McCloskey, E. (2008) · Osteoporosis International · doi:10.1007/s00198-007-0543-5 · Cited by 2,467 · see citing works
Subclinical Thyroid Disease: Scientific Review and Guidelines for Diagnosis and Management
Surks, M. I., Ortiz, E., Daniels, G. H., Sawin, C. T., Col, N. F., Cobin, R. H., Franklyn, J. A., Hershman, J. M., Burman, K. D., Denke, M. A., et al. (2004) · JAMA · doi:10.1001/jama.291.2.228 · Cited by 1,800 · see citing works
Role of Thyroid Hormones in Skeletal Development and Bone Maintenance
Bassett, J. H. D., & Williams, G. R. (2016) · Endocrine Reviews · doi:10.1210/er.2015-1106 · Cited by 540 · see citing works
Hyperthyroidism, Bone Mineral, and Fracture Risk—A Meta-Analysis
Vestergaard, P., & Mosekilde, L. (2003) · Thyroid · doi:10.1089/105072503322238854 · Cited by 306 · see citing works
Self-citationThe Thyrotropin Reference Range Should Remain Unchanged
Surks, M. I., Goswami, G., & Daniels, G. H. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-0170 · Cited by 287 · see citing works
Thyroid diseases and bone health
Williams, G. R., & Bassett, J. H. D. (2018) · Journal of Endocrinological Investigation · doi:10.1007/s40618-017-0753-4 · Cited by 276 · see citing works
Pathophysiology and treatment of osteoporosis: Challenges for clinical practice in older people
Barnsley, J., Buckland, G., Chan, P. E., Ong, A., Ramos, A. S., Baxter, M., Laskou, F., Dennison, E. M., Cooper, C., & Patel, H. P. (2021) · Aging Clinical and Experimental Research · doi:10.1007/s40520-021-01817-y · Cited by 199 · see citing works
Thayakaran, R., Adderley, N. J., Sainsbury, C., Torlinska, B., Boelaert, K., Šumilo, D., Price, M., Thomas, G. N., Toulis, K. A., & Nirantharakumar, K. (2019) · BMJ · doi:10.1136/bmj.l4892 · Cited by 138 · see citing works
The skeletal consequences of thyrotoxicosis
Nicholls, J. J., Brassill, M. J., Williams, G. R., & Bassett, J. H. D. (2012) · Journal of Endocrinology · doi:10.1530/joe-12-0059 · Cited by 138 · see citing works
Mazziotti, G., Sorvillo, F., Piscopo, M., Cioffi, M., Pilla, P., Biondi, B., Iorio, S., Giustina, A., Amato, G., & Carella, C. (2005) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.041126 · Cited by 126 · see citing works
Abrahamsen, B., Jørgensen, H. L., Laulund, A. S., Nybo, M., Brix, T. H., & Hegedüs, L. (2014) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.2244 · Cited by 112 · see citing works
Low normal TSH levels are associated with low bone mineral density in healthy postmenopausal women
Kim, D. J., Khang, Y. H., Koh, J., Shong, Y. K., & Kim, G. S. (2006) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2005.02422.x · Cited by 103 · see citing works
Subclinical Thyroid Dysfunction and the Risk for Fractures: A Systematic Review and Meta-analysis
Wirth, C. D., Blum, M. R., da Costa, B. R., Baumgartner, C., Collet, T.-H., Medici, M., Peeters, R. P., Aujesky, D., Bauer, D. C., & Rodondi, N. (2014) · Annals of Internal Medicine · doi:10.7326/m14-0125 · Cited by 85 · see citing works
Taylor, P. N., Lansdown, A., Witczak, J., Khan, R., Rees, A., Dayan, C. M., & Okosieme, O. (2023) · Thyroid Research · doi:10.1186/s13044-023-00149-5 · Cited by 72 · see citing works
“In addition, both hyperthyroidism and hypothyroidism increase frailty in the elderly and are associated with the development of myopathy [80], gait disorders [81], and fractures [10, 82].”
BackgroundA prospective study of thyroid function, bone loss, and fractures in older men: The MrOS study
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. (. (2013) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.1774 · Cited by 68 · see citing works
Garin, M. C., Arnold, A. M., Lee, J. S., Robbins, J., & Cappola, A. R. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-1051 · Cited by 65 · see citing works
Roef, G., Lapauw, B., Goemaere, S., Zmierczak, H., Fiers, T., Kaufman, J.-M., & Taes, Y. (2011) · European Journal of Endocrinology · doi:10.1530/eje-10-1113 · Cited by 54 · see citing works
Bassett, J. H. D., Boyde, A., Zikmund, T., Evans, H., Croucher, P. I., Zhu, X., Park, J. W., Cheng, S.-Y., & Williams, G. R. (2014) · Endocrinology · doi:10.1210/en.2013-2156 · Cited by 50 · see citing works
Papi, G., Pearce, E. N., Braverman, L. E., Betterle, C., & Roti, E. (2005) · The American Journal of Medicine · doi:10.1016/j.amjmed.2005.01.004 · Cited by 39 · see citing works
Karimifar, M., Karimifar, M., Salari, A., Esmaili, F., Faragzadegan, Z., & Kachuei, A. (2014) · Journal of Research in Pharmacy Practice · doi:10.4103/2279-042x.141099 · Cited by 30 · see citing works
Skov, J., Calissendorff, J., Eriksson, D., Magnusson, P., Kämpe, O., Bensing, S., & Kuja-Halkola, R. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa956 · Cited by 25 · see citing works
Ercolano, M. A., Drnovsek, M. L., Croome, M. C. S., Moos, M., Fuentes, A. M., Viale, F., Feldt-Rasmussen, U., & Gauna, A. T. (2013) · Thyroid Research · doi:10.1186/1756-6614-6-11 · Cited by 17 · see citing works
Hong, A. R., & Kang, H.-C. (2023) · Endocrinology and Metabolism · doi:10.3803/enm.2023.1701 · Cited by 15 · see citing works
Li, X., Zhang, T., Zhang, H., Liu, S., & Tian, L. (2025) · BMC Endocrine Disorders · doi:10.1186/s12902-024-01819-7 · Cited by 10 · see citing works
Hyperthyroidism-driven bone loss depends on BMP receptor Bmpr1a expression in osteoblasts
Lademann, F., Rijntjes, E., Köhrle, J., Tsourdi, E., Hofbauer, L. C., & Rauner, M. (2024) · Communications Biology · doi:10.1038/s42003-024-06227-0 · Cited by 8 · see citing works
Hyperthyroidism and Risk of Atrial Fibrillation or Flutter: A Population-Based Study
Frost, L., Vestergaard, P., & Mosekilde, L. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.15.1675
Self-citation
- Authors
- Vestergaard, P., & Mosekilde, L.
- Affiliations
- Aarhus University Hospital (DK)
- Venue
- Thyroid
- Publisher
- SAGE Publications
- Published
- 2002-05
- Volume
- 12
- Issue
- 5
- Pages
- 411-419
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W1944359201
- Cited by
- 289
- References
- 3
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 16 · 2023: 12 · 2022: 22 · 2021: 5 · 2020: 11 · 2019: 16 · 2018: 18 · 2017: 14 · 2016: 20 · 2015: 11 · 2014: 24 · 2013: 12 · 2012: 15
- FWCI
- 4.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- 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
- fracture, hyperthyroidism, hypothyroidism, fracture risk, thyroid surgery, Graves' disease, autoimmune hypothyroidism
- MeSH terms
- Adult, Aged, Biomechanical Phenomena, Bone and Bones, Denmark, Female, Follow-Up Studies, Goiter, Nodular, Humans, Hyperthyroidism, Hypothyroidism, Male, Middle Aged, Registries, Thyrotoxicosis, Reproducibility of Results, Cohort Studies, Absorptiometry, Photon, Bone Density, Treatment Outcome, Fractures, Bone
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