The DOI matches its Crossref record; 52 of the 53 references it cites were found in a registry or an index.
Risk for Fracture in Women with Low Serum Levels of Thyroid-Stimulating Hormone
Abstract
BACKGROUND: Biochemical evidence of hyperthyroidism may be associated with low bone mass, particularly in older postmenopausal women, but no prospective studies of thyroid function and subsequent fracture risk have been done. OBJECTIVE: To examine the association between low levels of thyroid-stimulating hormone (TSH) and fracture in older women. DESIGN: Prospective cohort study with case-cohort sampling. SETTING: Four clinical centers in the United States. PATIENTS: 686 women older than 65 years of age from a cohort of 9704 women recruited from population-based listings between 1986 and 1988. MEASUREMENTS: Baseline assessment of calcaneal bone mass, spine radiography, and history of thyroid disease. Spine radiography was repeated after a mean follow-up of 3.7 years; nonspine fractures were centrally adjudicated. Thyroid-stimulating hormone was measured in sera obtained at baseline from 148 women with new hip fractures, 149 women with new vertebral fractures, and a subsample of 398 women randomly selected from the cohort. RESULTS: After adjustment for age, history of previous hyperthyroidism, self-rated health, and use of estrogen and thyroid hormone, women with a low TSH level (0.1 mU/L) had a threefold increased risk for hip fracture (relative hazard, 3.6 [95% CI, 1.0 to 12.9]) and a fourfold increased risk for vertebral fracture (odds ratio, 4.5 [CI, 1.3 to 15.6]) compared with women who had normal TSH levels (0.5 to 5.5 mU/L). After adjustment for TSH level, a history of hyperthyroidism was associated with a twofold increase in hip fracture (relative hazard, 2.2 [CI, 1.0 to 4.4]), but use of thyroid hormone itself was not associated with increased risk for hip fracture (relative hazard, 0.5 [CI, 0.2 to 1.3]). CONCLUSIONS: Women older than 65 years of age who have low serum TSH levels, indicating physiologic hyperthyroidism, are at increased risk for new hip and vertebral fractures. Use of thyroid hormone itself does not increase risk for fracture if TSH levels are normal.
Overview
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
Verification
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?
The cited source says what the claim attributes to it.
In the citing paper
“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 [105]
In the citing paper
“If TH levels are elevated in the long term, patients will have a higher risk of atrial fibrillation, osteoporosis, and fracture (169, 170).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [169]
In the citing paper
“Evidence in the clinical literature suggests that there is an increased risk of bone fracture in individuals who are exposed to supratherapeutic doses of exogenous thyroid hormone for extended periods of time.”
From Diagnosis and management of treatment-refractory hypothyroidism: an expert consensus report (2017) · cites this paper as [96]
In the citing paper
“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 [105]
In the citing paper
“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 [408]
In the citing paper
“Some of these studies re-ported increased risks of overall mortality in older subjects (380,429), cardiovascular events (391), heart failure (381), and atrial fibrillation in all subjects (401) or in older subjects (384), and vertebral fractures in older women (408).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [408]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
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
Self-citationPerspective how many women have osteoporosis?
Melton, L. J., Chrischilles, E. A., Cooper, C. C., Lane, A. W., & Riggs, B. L. (1992) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.5650070902 · Cited by 1,400
Low Serum Thyrotropin Concentrations as a Risk Factor for Atrial Fibrillation in Older Persons
Sawin, C. T., Geller, A., Wolf, P. A., Belanger, A. J., Baker, E., Bacharach, P., Wilson, P., Benjamin, E. J., & D'Agostino, R. B. (1994) · New England Journal of Medicine · doi:10.1056/nejm199411103311901 · Cited by 1,259 · cited 1×
“1 mIU/L or less are highly correlated with a diminished response to thyroidreleasing hormone stimulation (33) and are associated with an increased incidence of atrial fibrillation (34).”
BackgroundMarkers of bone resorption predict hip fracture in elderly women: The EPIDOS prospective study
Garnero, P., Hausherr, E., Chapuy, M. C., Marcelli, C., Grandjean, H., Müller, C., Cormier, C., Bréart, G., Meunier, P. J., & Delmas, P. D. (1996) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.5650111021 · Cited by 984
Nevitt, M. C., Ettinger, B., Black, D. M., Stone, K. L., Jamal, S. A., Ensrud, K. E., Segal, M. R., Genant, H. K., & Cummings, S. R. (1998) · Annals of Internal Medicine · doi:10.7326/0003-4819-128-10-199805150-00001 · Cited by 841
Self-citationHow Many Women Have Osteoporosis?
Melton, L. J., Chrischilles, E. A., Cooper, C., Lane, A. W., & Riggs, B. L. (2005) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.2005.20.5.886 · Cited by 708
Analysis of Case-Cohort Designs
Barlow, W. E., Ichikawa, L., Rosner, D., & Izumi, S. (1999) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(99)00102-x · Cited by 682
Endogenous Hormones and the Risk of Hip and Vertebral Fractures among Older Women
Cummings, S. R., Browner, W. S., Bauer, D. C., Stone, K. L., Ensrud, K. E., Jamal, S. A., & Ettinger, B. B. (1998) · New England Journal of Medicine · doi:10.1056/nejm199809103391104 · Cited by 660
Self-citationGenant, H. K., Jergas, M. D., Palermo, L., Nevitt, M. C., Valentin, R. S., Black, D. M., & Cummings, S. R. (1996) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.5650110716 · Cited by 637
Self-citationFactors Associated with Appendicular Bone Mass in Older Women
Bauer, D. C., Browner, W. S., Cauley, J. A., ORWOLL, E. S., Scott, J. C., Black, D. M., Tao, J. L., & Cummings, S. R. (1993) · Annals of Internal Medicine · doi:10.7326/0003-4819-118-9-199305010-00001 · Cited by 563
Self-citation
Research works printed but not linked: 7
- 10.1001/jama.1989.03420180077034 · DOI · Paper page
- Auwerx J, 1986, Q J Med, 60, 737
- 10.1001/archinte.1995.00430110024003 · DOI
- Spencer CA, 1993, J Clin Endocrinol Metab, 76, 494
- Bauer DC, 1997, J Clin Endocrinol Metab, 82, 2931
- Cummings S, 1996, J Bone Miner Res, 11, S128
- Seppel T, 1996, J Clin Endocrinol Metab, 81, 1663
Cited by
Sorted by citations
Items 401–467 of 467
Cooper, M. S., & Gittoes, N. J. L. (2005) · Adverse Drug Reaction Bulletin · doi:10.1097/00012995-200512000-00001
Bauer, D. C. (2011) · Annals of Internal Medicine · doi:10.7326/0003-4819-155-6-201109200-02005
Self-citationAnliker, M., Bieglmayer, C., Dimai, H. P., Gasser, R. W., Kudlacek, S., Obermayer-Pietsch, B. M., Schmidt‐Gayk, H., Sottara, E., Woloszczuk, W., Zwettler, E., et al. (2009) · Journal of Laboratory Medicine · doi:10.1515/jlm.2009.029
An elderly woman with weight loss and diarrhoea
Mitchell, A., & Pearce, S. H. S. (2009) · BMJ · doi:10.1136/bmj.b1721
Modular Goiter: Results of Prospective Countroled Studies
Haikina, I. A., & Fadeev, V. V. (2008) · Clinical and experimental thyroidology · doi:10.14341/ket20084224-32
Laboratory diagnostics in the prevention, differential diagnosis, and monitoring of osteoporosis1
Anliker, M., Bieglmayer, C., Dimai, H. P., Gasser, R. W., Kudlacek, S., Obermayer-Pietsch, B. M., Schmidt‐Gayk, H., Sottara, E., Woloszczuk, W., Zwettler, E., et al. (2009) · Journal of Laboratory Medicine · doi:10.1515/jlm.2009.029et
Should we treat subclinical hyperthyroidism?
Franklyn, J. A. (2008) · Nature Clinical Practice Endocrinology & Metabolism · doi:10.1038/ncpendmet0917
Subklinische schildklierafwijkingen bij ouderen
Wijsman, L. W., den Elzen, W. P. J., Virgini, V. S., Rodondi, N., Bauer, D. C., Kearney, P. M., Jukema, J. W., Westendorp, R. G. J., Ford, I., Stott, D. J., et al. (2015) · Huisarts en Wetenschap · doi:10.1007/s12445-015-0010-z
Self-citationCallear, J., Jerjes, W., Tan, H., & Giannoudis, P. V. (2012) · Hard Tissue · doi:10.13172/2050-2303-1-1-255
Long-term Prognosis of Patients Treated With Radioactive Iodine for Hyperthyroidism
Metso, S. (2007) · Tampere University Institutional Repository (Tampere University)
Umfelddiagnostik bei der Osteoporose
Kasperk, C. (2014) · Trauma und Berufskrankheit · doi:10.1007/s10039-014-2097-z
Physical Exercise for Secondary Osteoporosis
Mina, D. S. (2012) · The Open Bone Journal · doi:10.2174/1876525401204010001
Pituitary Hormones and the Pathophysiology of Osteoporosis
Agrawal, M., Arora, S., Colaianni, G., Sun, L., Iqbal, J. Z., & Zaidi, M. (2012) · Springer eBooks · doi:10.1007/978-1-4471-2745-1_5
Miller, M. (2010) · Elsevier eBooks · doi:10.1016/b978-1-4160-6231-8.10090-x
Risks of Thyroid Hormone Suppression for Differentiated Thyroid Cancer in the Elderly
Yalamanchi, S., & Cooper, D. K. C. (2015) · Springer eBooks · doi:10.1007/978-3-319-22401-5_18
États Pathologiques et cas Particuliers
Johnston, S. L., Graves, G. R., & Kendler, D. L. (2001) · Journal SOGC · doi:10.1016/s0849-5831(16)30990-9
Medical and Special Conditions
Johnston, S. L., Graves, G. R., Kendler, D. L., & Fluker, M. R. (2001) · Journal SOGC · doi:10.1016/s0849-5831(16)30987-9
Thyroid Disease in the Elderly
Cappola, A. R., Miller, M., & Gambert, S. R. (2016) · doi:10.3109/9781420070651-13
Management of Bone Disease in Candidates for Organ Transplant
Ott, S. M. (2005) · Elsevier eBooks · doi:10.1016/b978-012183502-6/50023-7
Sarkar, S. D. (2015)
atualizacão Disfunções Mínimas da Tiróide: Hipotiroidismo Subclínico e Hipertiroidismo Subclínico
Romaldini, J. H., Sgarbi, J. A., & Farah, C. S. (2004)
Iperfunzione tiroidea nell’anziano
Pasqualetti, G., Ilacqua, A., Niccolai, F., Belfiore, A., & Monzani, F. (2016) · L Endocrinologo · doi:10.1007/s40619-016-0232-8
OSTEOPOROSIS PADA HIPERTIROIDISME
Salwani, D. (2013) · DOAJ (DOAJ: Directory of Open Access Journals) · doi:10.24815/jks.v13i3.3423
Faut-il faire un dosage systématique de la TSH à l’admission en court séjour gériatrique ?
Kobeh, D., Janin, H., Regueme, S. C., & Bourdel‐Marchasson, I. (2017) · NPG. Neurologie, psychiatrie, gériatrie/NPG · doi:10.1016/j.npg.2017.05.007
Local and Systemic Treatment of Unresectable Disease
Busaidy, N. L., & Jaber, T. (2017) · Springer eBooks · doi:10.1007/978-3-319-54493-9_21
Neethu, K. P., Santhosh Kumar, S. S., & Joseph, M. (2017) · Journal of Evidence Based Medicine and Healthcare · doi:10.18410/jebmh/2017/1191
Reyes‐García, R., Gimeno, E. J., & Martín, A. G. (2014) · Elsevier eBooks · doi:10.1016/b978-84-9022-503-5.00023-x
The Pituitary–Bone Axis in Health and Disease
Zaidi, M., Yuen, T., Abu-Amer, W., Liu, P., Davies, T., New, M., Blair, H., Zallone, A., Rosen, C., & Sun, L. (2018) · Primer on the metabolic bone diseases and disorders of mineral metabolism · doi:10.1002/9781119266594.ch133
Janssen, O. E., & Bullmann, C. (2019) · Der Nuklearmediziner · doi:10.1055/a-0916-6728
Hennessey, J. V. (2019) · Springer eBooks · doi:10.1007/978-3-030-22720-3_20
Thyroid Hormone Action on the Skeleton and Growth
Williams, G. R. (2003) · Encyclopedia of Hormones · doi:10.1016/b0-12-341103-3/00284-9
Is a Computer Program Better Than Clinicians at Adjusting Levothyroxine After Thyroidectomy?
Drake, T. C. (2021) · Clinical Thyroidology · doi:10.1089/ct.2021;33.305-308
Osteopatías fragilizantes endocrinas
Rochoux, Q., & Marcelli, C. (2021) · EMC - Aparato Locomotor · doi:10.1016/s1286-935x(21)45565-6
Osteoporosi indotta da farmaci
Ravazzoli, M., Tamone, C., & Isaia, G. (2009) · Springer eBooks · doi:10.1007/978-88-470-1357-5_10
Thyroid Disorders and Bone Disease
Watts, L. M., Freudenthal, B., Bassett, J. H. D., & Williams, G. R. (2022) · doi:10.1093/med/9780198870197.003.0089
Regulation of Bone Mass and Body Composition by Anterior Pituitary Hormones
Zaidi, M., Khan, A., Sharma, A., Ataebiekov, I., Hadelia, E., Korkmaz, F., Iqbal, J., Yuen, T., & Lizneva, D. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-801238-3.62238-9
Sarkar, S. D. (2014) · Springer eBooks · doi:10.1007/978-3-319-06112-2_7
Luíz, H. V., Manita, I., & Portugal, J. (2016) · Springer eBooks · doi:10.1007/978-3-319-25871-3_7
(2006) · Springer eBooks · doi:10.1007/1-84628-006-0_6
Medical and Special Conditions
Johnston, S. L., Graves, G. R., Kendler, D. L., & Fluker, M. R. (2002) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/s1701-2163(17)31081-2
Thyroid disorders and bone disease
Cheung, M., Gogakos, A. I., Bassett, J. H. D., & Williams, G. R. (2011) · doi:10.1093/med/9780199235292.003.0465
Franklyn, J. A. (2011) · doi:10.1093/med/9780199235292.003.3177
Pearce, E. N., & Braverman, L. E. (2003) · Humana Press eBooks · doi:10.1007/978-1-59259-378-1_3
Christ‐Crain, M., Meier, C., Staub, J. J., Guglielmetti, M., Huber, P., Alscher, S., & Müller-Stich, B. P. (2002) · De Gruyter eBooks · doi:10.1515/9783110877472.131
Biondi, B., Palmieri, E. A., Lombardi, G., & Fazio, S. (2004) · Elsevier eBooks · doi:10.1016/b0-12-475570-4/00675-2
(2018) · Elsevier eBooks · doi:10.1016/b978-3-437-22102-6.00004-4
Risks of Thyroid Hormone Suppression for Differentiated Thyroid Cancer in the Elderly
Yalamanchi, S., & Cooper, D. S. (2020) · Springer eBooks · doi:10.1007/978-3-030-61919-0_17
Мінеральна щільність та метаболізм кісткової тканини у разі тиреотоксикозу
Стойка, В. В. (2022) · Науковий вісник Ужгородського університету Серія Медицина · doi:10.32782/2415-8127.2022.65.8
Jeon, Y. K., Kim, D., Kim, M., Kim, B. H., & Keun-young Kim, A. (2024) · Research Square · doi:10.21203/rs.3.rs-4220569/v1
Hanmayyagari, B. (2020) · IAR Journal of Medicine and Surgery Research · doi:10.47310/iarjmsr.2020.v01i01.06
Lau, A. N. C., & Cheung, A. M. (2023) · Endocrinology · doi:10.1007/978-3-030-19632-5_16-1 · Cited by 1
The effect of periodontal status on the TSH and FT4 levels
Üner, D. D., & İzol, B. S. (2024) · Journal of Oral Health and Oral Epidemiology · doi:10.34172/johoe.2202.1456
Thyroid Disease in Older Persons
Sawin, C. T. (2003) · Humana Press eBooks · doi:10.1007/978-1-59259-352-1_6
Assessment of periostin in postmenopausal thyroid patients: A prospective case-control study
Gupta, A. K., Faruqui, S., & Jha, A. N. (2025) · Endocrine and Metabolic Science · doi:10.1016/j.endmts.2025.100270
Scharla, S. H. (2025) · Elsevier eBooks · doi:10.1016/b978-3-437-21184-3.00009-0
Hintze, G., & Mann, K. (2025) · Elsevier eBooks · doi:10.1016/b978-3-437-21184-3.00002-8
CQ11. Does TSH Suppression Therapy Reduce the Size of Tumors Diagnosed as Benign?
Suzuki, S., Fukunari, N., Kameyama, K., Miyakawa, M., Tanaka, K., & Hibi, Y. (2012) · Springer eBooks · doi:10.1007/978-4-431-54049-6_16
Biondi, B. (2018) · Elsevier eBooks · doi:10.1016/b978-0-443-13825-6.00420-9
Thyroid and osteoporosis: Pathophysiology, clinical consequences, and management
Ghosh, A., & Sanjeev, K. N. (2026) · Thyroid Research and Practice · doi:10.4103/trp.trp_28_25
Karatepe, B. A., Çil, B. Ö., Karagöz, Z. K., Altun, G., & Hoşgün, D. (2026) · BMC Pulmonary Medicine · doi:10.1186/s12890-026-04590-8
The association between thyroid function and bone mass density
Profili, N. I., Makrogiannis, S. K., Marongiu, M., Fiorillo, E., Cucca, F., & Delitala, A. (2026) · Bone · doi:10.1016/j.bone.2026.118055
Ghotbi, E., McGready, J., Hadidchi, R., Ibad, H. A., Simonsick, E. M., Xue, Q., Demehri, S., & Mammen, J. S. (2026) · Bone · doi:10.1016/j.bone.2026.118100
Subclinical Hyperthyroidism Due to a Multinodular Thyroid
Aoun, P., & Cooper, D. S. (2008) · Humana Press eBooks · doi:10.1007/978-1-60327-103-5_6
Osteoporosi nelle malattie endocrine
Cianferotti, L., & Marcocci, C. (2009) · Springer eBooks · doi:10.1007/978-88-470-1357-5_13
Metadata
- Authors
- Bauer, D. C., Ettinger, B., Nevitt, M. C., Stone, K. L., & for the Study of Osteoporotic Fractures Research Group
- Affiliations
- University of Minnesota (US)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2001-04-03
- Volume
- 134
- Issue
- 7
- Pages
- 561-568
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W1992692011
- Cited by
- 467
- References
- 53
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 9 · 2023: 16 · 2022: 15 · 2021: 17 · 2020: 15 · 2019: 12 · 2018: 22 · 2017: 19 · 2016: 23 · 2015: 16 · 2014: 30 · 2013: 23 · 2012: 35
- FWCI
- 14.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5k08ag000629-03)
- National Institute on Aging (K08-AG-00629)
- 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, fracture risk, hyperthyroidism, hip fracture, vertebral fractures, postmenopausal women, older women, bone mass, thyroid hormone replacement, osteoporosis
- MeSH terms
- Aged, Follow-Up Studies, Hip Fractures, Humans, Hyperthyroidism, Male, Prospective Studies, Risk Factors, Thyroid Hormones, Thyrotropin, Bone Density, Estrogen Replacement Therapy, Case-Control Studies, Spinal Fractures, Postmenopause, Fractures, Bone
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
