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Effect of subclinical hyperthyroidism on osteoporosis: A meta-analysis of cohort studies

Endocrine volume 69, pages 39–48 (2020)Cite this article

Abstract

Objective

The effect of subclinical hyperthyroidism (SH) on bone mineral density (BMD) remains unclear, as do the linking mechanisms. This review aims to investigate the relationship between SH and bone loss in terms of the gender-dependent effects of SH on BMD.

Methods

The PUBMED, EMBASE, OVID, MEDLINE, SINOMED and COCHRANE LIBRARY databases (inception to August 12, 2019) were searched for cohort studies investigating the effects of SH on BMD. Eligible studies were subjected to qualitative and quantitative analysis using a random-effects model meta-analysis with the Cochrane systematic evaluation method.

Results

Twelve cohort studies involving 275,086 participants who were followed for 3 months to 13 years were included based on predefined inclusion and exclusion criteria. The results indicated that SH did not affect lumbar spine BMD in females or males. However, a significant reduction in femoral neck BMD was observed in females, but not in males. Further, there was a significant increase in hip fractures events in both females and males with SH.

Conclusions

The present findings indicate that SH is significantly associated with hip fracture risk, and therefore, it is important to assess the risk of fractures in patients with SH. Future studies should focus on methods for accurately determining this risk in patients with SH and providing them with timely and efficient diagnosis and treatment.

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Abbreviations

SH:

subclinical hyperthyroidism

BMD:

bone mineral density

TSH:

thyroid stimulating hormone

FT4:

free T4

FT3:

free T3

TT3:

total T3

TT4:

total T4

IPD:

individual participant data

Ca:

calcium concentration

P:

phosphorus concentration

NTx:

N-telopeptide of type I collagen

CTx:

C-telopeptide of type I collagen

ALP:

osteocalcin, alkaline phosphatase

PTH:

parathyroid hormone

HIF1α:

hypoxia inducible factor 1 alpha

DHEA:

dehydroepiandrosterone

DHEAS:

dehydroepiandrosterone sulfate

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Acknowledgements

Grateful acknowledgment is made to Mr. Hong Chen who gave me considerable help and encouragement. I also owe a special debt of gratitude to Mr. Rongping Chen, from whose devoted teaching and enlightening lectures I have benefited a lot and prepared for the paper.

Funding

This work was supported by the Science and Technology Planning Project of Guangdong Province, China (Grant no. 2014A020212177) and the National Natural Science Foundation of China (Grant no. 81500623 and 81770804).

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  1. These authors contributed equally: Ningning Xu, Yaxian Wang

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  1. Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China

    Ningning Xu, Yaxian Wang, Yuying Xu, Lishan Li, Jiaqi Chen, Xudong Mai, Jie Xu, Zhen Zhang, Rui Yang, Jia Sun, Hong Chen & Rongping Chen

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Xu, N., Wang, Y., Xu, Y. et al. Effect of subclinical hyperthyroidism on osteoporosis: A meta-analysis of cohort studies. Endocrine 69, 39–48 (2020). https://doi.org/10.1007/s12020-020-02259-8

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Keywords

  • Bone health
  • Hyperthyroidism
  • Meta-analysis
  • Osteoporosis
  • Fracture risk
  • Review