Low bone mineral density is related to high physiological levels of free thyroxine in peri-menopausal women

Abstract

OBJECTIVE: To determine whether thyroid hormone (free thyroxine (fT₄)) rather than TSH is directly related to bone mineral density (BMD). DESIGN: Cross-sectional population cohort study of peri-menopausal women. METHODS: Of a sample of 6846 peri-menopausal Dutch women who participated in an osteoporosis-screening programme, a cohort of 2584 was randomly selected for the assessment of thyroid function (TSH, fT₄ and thyroid peroxidase antibodies (TPO-Abs)). TPO-Ab-positive women, with a previous history of thyroid dysfunction, overt thyroid disease, subclinical hypothyroidism, osteoporosis or bilateral oophorectomy and those receiving thyroid hormone or hormone replacement therapy were excluded. Of 1477 eligible women, 1426 had TSH and fT₄ within the reference range and 51 had low or undetectable serum TSH. BMD was measured at the lumbar spine and low BMD was defined as <0.937 g/cm(2). RESULTS: The mean BMD in the 51 women with low or undetectable serum TSH was 0.984 g/cm(2) compared with 1.001 g/cm(2) in the remaining 1426 (t=0.94, P=0.35); 33% of women with low or undetectable serum TSH had low BMD compared with 34% in 1426 euthyroid women. High fT₄ but not low TSH in euthyroid women was related to low BMD by multiple logistic regression corrected for age, BMI and smoking (OR, 1.30; 95% CI, 1.02-1.69). CONCLUSIONS: Higher fT₄ levels within the normal reference range but not low or undetectable serum TSH were independently related to decreased BMD at lumbar spine in peri-menopausal women.