J Bone Metab.  2014 Aug;21(3):213-216. 10.11005/jbm.2014.21.3.213.

Bone Health and Clinical Results after Hip Fracture Surgery in Patients with Subclinical Hypothyroidism

• Kim KC
• Lee YK
• Lee YJ
• Ha YC
• Koo KH

• KMID: 2286291
• DOI: http://doi.org/10.11005/jbm.2014.21.3.213

Abstract

BACKGROUND
Subclinical thyroid dysfunction might influence a bone health. We evaluated whether subclinical hypothyroidism adversely affects bone health including bone mineral density (BMD), level of vitamin D, and bone turnover status in patients with hip fracture.
METHODS
We evaluated 471 patients aged 50 years or older, who underwent hip fracture surgeries. BMD, level of vitamin D, bone turnover status, and one-year mortality were compared between subclinical hypothyroidism group and control group.
RESULTS
BMD of femur and the level of 25-hydroxy-vitamin D (25-[OH]D) were similar in the two groups. There were no significant differences in bone turnover markers according to thyroid function. No significant differences were observed between the groups in utilization of intensive care unit (ICU), length of hospital stay, mobility, and one-year mortality.
CONCLUSIONS
Subclinical hypothyroidism was not associated with reduced bone health, including BMD, the level of 25-(OH)D, and bone turnover marker.

Keyword

Bone density; Fractures bone; Hip fractures; Hypothyroidism

MeSH Terms

Bone Density
Femur
Hip Fractures
Hip*
Humans
Hypothyroidism*
Intensive Care Units
Length of Stay
Mortality
Thyroid Gland
Vitamin D
Vitamin D

Reference

1. Roberts CG, Ladenson PW. Hypothyroidism. Lancet. 2004; 363:793–803.

2. Vestergaard P, Weeke J, Hoeck HC, et al. Fractures in patients with primary idiopathic hypothyroidism. Thyroid. 2000; 10:335–340.

3. Coindre JM, David JP, Rivière L, et al. Bone loss in hypothyroidism with hormone replacement. A histomorphometric study. Arch Intern Med. 1986; 146:48–53.

4. Jayme JJ, Ladenson PW. Subclinical thyroid dysfunction in the elderly. Trends Endocrinol Metab. 1994; 5:79–86.

5. Canaris GJ, Manowitz NR, Mayor G, et al. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000; 160:526–534.

6. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002; 87:489–499.

7. Kim YA, Park YJ. Prevalence and risk factors of subclinical thyroid disease. Endocrinol Metab. 2014; 29:20–29.

8. Sawin CT, Castelli WP, Hershman JM, et al. The aging thyroid. Thyroid deficiency in the Framingham Study. Arch Intern Med. 1985; 145:1386–1388.

9. Tunbridge WM, Evered DC, Hall R, et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf). 1977; 7:481–493.

10. Lee YK, Lee YJ, Ha YC, et al. Five-year relative survival of patients with osteoporotic hip fracture. J Clin Endocrinol Metab. 2014; 99:97–100.

11. Yoon HK, Park C, Jang S, et al. Incidence and mortality following hip fracture in Korea. J Korean Med Sci. 2011; 26:1087–1092.

12. Park C, Ha YC, Jang S, et al. The incidence and residual lifetime risk of osteoporosis-related fractures in Korea. J Bone Miner Metab. 2011; 29:744–751.

13. Kang BJ, Lee YK, Lee KW, et al. Mortality after hip fractures in nonagenarians. J Bone Metab. 2012; 19:83–86.

14. Park YJ, Yoon JW, Kim KI, et al. Subclinical hypothyroidism might increase the risk of transient atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg. 2009; 87:1846–1852.

15. Koval KJ, Aharonoff GB, Rosenberg AD, et al. Functional outcome after hip fracture. Effect of general versus regional anesthesia. Clin Orthop Relat Res. 1998; 37–41.

16. Shin CS, Choi HJ, Kim MJ, et al. Prevalence and risk factors of osteoporosis in Korea: a community-based cohort study with lumbar spine and hip bone mineral density. Bone. 2010; 47:378–387.

17. Rozental TD, Shah J, Chacko AT, et al. Prevalence and predictors of osteoporosis risk in orthopaedic patients. Clin Orthop Relat Res. 2010; 468:1765–1772.

18. Marwaha RK, Garg MK, Tandon N, et al. Thyroid function and bone mineral density among Indian subjects. Indian J Endocrinol Metab. 2012; 16:575–579.

19. Bertoli A, Fusco A, Andreoli A, et al. Effect of subclinical hypothyroidism and obesity on whole-body and regional bone mineral content. Horm Res. 2002; 57:79–84.

20. Meier C, Beat M, Guglielmetti M, et al. Restoration of euthyroidism accelerates bone turnover in patients with subclinical hypothyroidism: a randomized controlled trial. Osteoporos Int. 2004; 15:209–216.

21. Woeber KA. Subclinical thyroid dysfunction. Arch Intern Med. 1997; 157:1065–1068.

22. Pines A, Dotan I, Tabori U, et al. L-thyroxine prevents the bone-conserving effect of HRT in postmenopausal women with subclinical hypothyroidism. Gynecol Endocrinol. 1999; 13:196–201.

23. Lakatos P. Thyroid hormones: beneficial or deleterious for bone? Calcif Tissue Int. 2003; 73:205–209.

24. Haentjens P, Van Meerhaeghe A, Poppe K, et al. Subclinical thyroid dysfunction and mortality: an estimate of relative and absolute excess all-cause mortality based on time-to-event data from cohort studies. Eur J Endocrinol. 2008; 159:329–341.

25. Kalra S, Williams A, Whitaker R, et al. Subclinical thyroid dysfunction does not affect one-year mortality in elderly patients after hip fracture: a prospective longitudinal study. Injury. 2010; 41:385–387.

26. Weller I, Wai EK, Jaglal S, et al. The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Joint Surg Br. 2005; 87:361–366.

27. Kenzora JE, McCarthy RE, Lowell JD, et al. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res. 1984; 45–56.

28. Lee KH, Ha YC, Lee YK, et al. Frequency, risk factors, and prognosis of prolonged delirium in elderly patients after hip fracture surgery. Clin Orthop Relat Res. 2011; 469:2612–2620.

29. Ruiz-Tovar J, Boix E, Galindo I, et al. Evolution of subclinical hypothyroidism and its relation with glucose and triglycerides levels in morbidly obese patients after undergoing sleeve gastrectomy as bariatric procedure. Obes Surg. 2014; 24:791–795.