Fracture risk in subclinical thyroid dysfunction.

Beograd : [S. P. Polovina]

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Endokrinologija / Endocrinology

Cilj studije preseka je bio da ispita povezanost između TSH i rizika od preloma kostiju u populaciji pre i postmenopauzalnih žena sa subkliničkim hiper i hipotireoidizmom, sa ciljem prepoznavanja osoba sa povećanim rizikom od osteoporotičnih fraktura. METODOLOGIJA Računanje FRAX skora (10-godišnji pretpostavljeni rizik od preloma kostiju) i merenje koštanih markera je primenjeno na 109 pre i postmenopauzalnih žena sa novootkrivenim subkliničkim hiper ili hipotiroidizmom, starosti 59.17±7.07 godina, prosečnog indeksa telesne mase 27.89 ±3.46kg/m2, sa nastankom menopauze u 48.05±4.09 godini života i na 51 eutireoidnoj ženi, starosti 69±5.72, ITM 27.68 ± 4.66kg/m2, sa nastankom menopauze u 48.53±4.58 godini. REZULTATI: Ukupni FRAX skor i FRAX za kuk je bio značajno veći u podgrupi sa subkliničkim hipotireoidizmom (p<0.001 i p=0.001). U podgrupi sa subkliničkim hipertireoidizmom je ukupni FRAX skor bio statistički značajno povećan (p=0.001). Nije bilo povezanosti između niskog TSH i frakturnog rizika. U podgrupi sa subkliničkim hipotireoidizmom je nađena povezanost između TSH i osteokalcina (p=0.02) i postojanja TPO antitela i ukupnog frakturnog rizika ( p=0.001). ZAKLJUČAK: Pre i postmenopauzalne žene sa subkliničkom tireoidnom bolešću, posebno autoimune prirode, imaju veći FRAX skore i time i veći rizik od preloma kuka i drugih kostiju na malu trauma, u odnosu na pre i postmenopauzalne žene bez tireoidne disfunkcije. Naši rezultati ukazuju na potrebu ispitivanja kvaliteta kostiju populacije perimenopauzalnih žena sa subkliničkom tireoidnom bolešću u cilju sprečavanja nastanka osteoporotičnih preloma kostiju.

OBJECTIVE: The aim of our cross-sectional study was to evaluate the relationship between the TSH and fracture risk in pre and postmenopausal women with subclinical hyper or hypothyroidism for evaluation of individuals with a high risk for osteoporotic fractures. DESIGN: FRAX score calculation (10-year estimated risk for bone fracture) and measurement of bone markers were performed in 109 pre and postmenopausal women with newly discovered subclinical hypothyroidism (mean age 59.17±7.07, mean BMI 27.89 ±3.46kg/m2, menopause onset in 48.05±4.09 years of age) and 51 matched controls (mean age 59.69±5.72, mean BMI 27.68 ± 4.66kg/m2, menopause onset in 48.53±4.58 years of age) with normal thyroid function. RESULTS: The main FRAX score and hip FRAX score were significantly higher in the subgroup with subclinical hypothyroidism than in the controls (p<0.001 and p=0.001). In subgroup with subclinical hyperthyroidism main FRAX score was statisticaly significant (p=0.001). There was no correlations between low TSH and fracture risk. There was significant correlations between osteocalcin and TSH (p=0.02) in subgroup with subclinical hypothyroidism. Significant correlations was founded between presence of TPOAb and main FRAX in subgroup with subclinical hypothyroidism (p=0.001). CONCLUSIONS: Perimenopausal women with subclinical thyroid dysfunctions, in particular of autoimmune origin, have higher FRAX scores and a thus greater risk for low-trauma hip and other site fractures than euthyroid postmenopausal women. Our results point to the need of monitoring perimenopausal women with subclinical hypothyroidism and hyperthyroidism for avoidance of fractures.

FRAX skor, koštani marker, subklinički hipotireoidizam, subklinički hipertireoidizam, TSH, žene u perimenopauzi

FRAX score, bone markers, subclinical hypothyroidism, TSH, perimenopausal women

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