RETRACTED ARTICLE: The relationship between subclinical thyroid dysfunction and the risk of fracture or low bone mineral density: a systematic review and meta-analysis of cohort studies
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Our aim was to assess the risk of fractures or low bone mineral density (BMD) associated with subclinical thyroid dysfunction among cohorts. We systematically searched Medline (via PubMed), EMBASE, Cochrane Library, Web of Science, CENTRAL and SinoMed up to 31 July 2016 to identify cohort studies which have analyzed associations between subclinical thyroid dysfunction and fracture or BMD. A total of 19 population-based cohorts including 79,368 participants with relationships between subclinical thyroid dysfunction and fractures or BMD were identified as eligible for this meta-analysis. Subclinical hypothyroidism was associated with relative risks (RRs) of 1.34 (95% confidence interval [CI] 1.14, 1.58; I 2 = 32%) for hip fracture, 1.27 (95% CI 1.02, 1.58; I 2 = 51.9%) for any location of fracture, and 1.25 (95% CI 1.04, 1.50) for forearm fracture. Subclinical hyperthyroidism was associated with RRs of 1.71 (95% CI 1.06, 2.76; I 2 = 0.0%) for spine fracture, 1.20 (95% CI 1.03, 1.39; I 2 = 0.0%) for non-spine fracture, 1.44 (95% CI 1.21, 1.71; I 2 = 0.0%) for hip fracture, and 1.38 (95% CI 1.21, 1.58; I 2 = 0.0%) for any location of fracture. Subgroup analysis was conducted according to whether thyroid/anti-thyroid drug users were excluded or not and the results were similar. The change in BMD at the hip (weighted mean difference [WMD] = −0.060, 95% CI −0.116, −0.004; I 2 = 0.0%) and femoral neck (WMD = −0.046, 95% CI −0.077, −0.015; I 2 = 0.0%) was significantly decreased in the subclinical hyperthyroidism group compared with the euthyroidism groups in females. We failed to find any associations between the change in BMD and subclinical hypothyroidism. The overall quality of evidence was low in all outcomes. Subclinical hyperthyroidism and subclinical hypothyroidism were associated with an increased risk of fractures. Although subclinical hyperthyroidism was related to reduced BMD, no evidence could prove a definite association between subclinical hypothyroidism and the risk of low BMD.
KeywordsSubclinical hypothyroidism Subclinical hyperthyroidism Fracture Bone mineral density
The authors thank the Tian JH, Bai ZG and Yang KH (Evidence Based Medicine Center of Lanzhou University) for their help and support with the methodology and meta-processing.
LT conceived and designed the experiments; RY performed the experiments; RY, YF, and JS analyzed the data; RY wrote the paper; and LT, K-HY, and LY offered suggestions.
Compliance wih ethical standards
Conflict of interest
- 4.National Osteoporosis Foundation (2002). America’s bone Health: the state of osteoporosis and low bone mass in our nation. National Osteoporosis Foundation, Washington, DCGoogle Scholar
- 6.National Guideline C (2014) Management and prevention of osteoporosis. Agency for Healthcare Research and Quality (AHRQ), Rockville, MD. https://www.guideline.gov/summaries/summary/47804/management-and-prevention-of-osteoporosis
- 17.Zhang YJ (2009) Clinical analysis of clinical and subclinical hyperthyroidism in patients with bone mineral density. Neimeng Med J 4:434–437Google Scholar
- 22.Finigan J, Greenfield DM, Blumsohn A, Hannon RA, Peel NF, Jiang G, Eastell R (2008) Risk factors for vertebral and nonvertebral fracture over 10 years: a population-based study in women. J Bone Miner Res 23:5–85Google Scholar
- 29.Nanchen D, Gussekloo J, Westendorp RG, Stott DJ, Jukema JW, Trompet S, Ford I, Welsh P, Sattar N, Macfarlane PW, Mooijaart SP, Rodondi N, de Craen AJ, PROSPER Group (2012) Subclinical thyroid dysfunction and the risk of heart failure in older persons at high cardiovascular risk. J Clin Endocrinol Metab 97:852–861CrossRefGoogle Scholar
- 31.Murphy E, Glüer CC, Reid DM, Felsenberg D, Roux C, Eastell R, Williams GR (2010) Thyroid function within the upper normal range is associated with reduced bone mineral density and an increased risk of nonvertebral fractures in healthy euthyroid postmenopausal women. J Clin Endocrinol Metab 95:3173–3181CrossRefGoogle Scholar
- 32.Ceresini G, Ceda GP, Lauretani F, Maggio M, Usberti E, Marina M, Bandinelli S, Guralnik JM, Valenti G, Ferrucci L (2013) Thyroid status and 6-year mortality in elderly people living in a mildly iodine-deficient area: the aging in the Chianti Area Study. J Am Geriatr Soc 61:868–874CrossRefGoogle Scholar
- 35.Mendonça Monteiro de Barros G, Madeira M, Vieira Neto L, de Paula Paranhos Neto F, Carvalho Mendonça LM, Corrêa Barbosa Lima I, Corbo R, Fleiuss Farias ML (2016) Bone mineral density and bone microarchitecture after long-term suppressive levothyroxine treatment of differentiated thyroid carcinoma in young adult patients. J Bone Miner Metab 34:417–421CrossRefGoogle Scholar
- 42.Bassett JH, Williams AJ, Murphy E, Boyde A, Howell PG, Swinhoe R, Archanco M, Flamant F, Samarut J, Costagliola S, Vassart G, Weiss RE, Refetoff S, Williams GR (2008) A lack of thyroid hormones rather than excess thyrotropin causes abnormal skeletal development in hypothyroidism. Mol Endocrinol 22:501–512CrossRefGoogle Scholar
- 44.Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) Group. JAMA 283:2008–2012CrossRefGoogle Scholar