Higher serum free thyroxine levels are associated with increased risk of hip fractures in older men
Journal article
Svensson, Johan, Ohlsson, Claes, Karlsson, Magnus K., Herlitz, Hans, Lorentzon, Mattias, Lewerin, Catharina and Mellström, Dan. (2024). Higher serum free thyroxine levels are associated with increased risk of hip fractures in older men. Journal of Bone and Mineral Research. 39(1), pp. 50-58. https://doi.org/10.1093/jbmr/zjad005
Authors | Svensson, Johan, Ohlsson, Claes, Karlsson, Magnus K., Herlitz, Hans, Lorentzon, Mattias, Lewerin, Catharina and Mellström, Dan |
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Abstract | Overt and subclinical hyperthyroidism are associated with an increased fracture risk, but whether thyroid hormones are associated with fracture risk in individuals with normal thyroid-stimulating hormone (TSH) has mostly been investigated in women. Therefore, we investigated if serum levels of free thyroxine (FT4) or TSH are associated with fracture risk in Swedish men. We followed (median 12.2 yr) elderly men (n = 1825; mean age 75, range 69–81 yr) participating in the Gothenburg and Malmö subcohorts of the prospective, population-based MrOS-Sweden study. The statistical analyses included Cox proportional hazards regression. Men receiving levothyroxine treatment were excluded. In our total cohort, serum FT4 (per SD increase) was associated with increased risk of major osteoporotic fractures (MOFs; n = 479; fully adjusted hazard ratio [HR] 1.14, 95% CI, 1.05–1.24) and hip fractures (n = 207; HR 1.18, 95% CI, 1.04–1.33). Also, in men with normal TSH (n = 1658), FT4 (per SD increase) was significantly associated with increased risk of MOF and hip fractures. Furthermore, men in the highest FT4 quartile had a 1.5-fold increase in hip fracture risk compared with men in the three lower FT4 quartiles, both in the total population and in men with normal TSH (fully adjusted: HR 1.45, 95% CI, 1.04–2.02 and HR 1.51, 95% CI, 1.07–2.12, respectively). In contrast, the risk of MOF was not statistically different in the highest FT4 quartile compared with the three lower FT4 quartiles. Finally, serum TSH was not associated with fracture risk after full adjustment for covariates. In conclusion, serum FT4, but not serum TSH, is a predictor of hip fracture risk in elderly Swedish men. Additionally, there was an association between FT4 (per SD increase) and the risk of MOF. |
Keywords | serum free thyroxine; serum thyroid-stimulating hormone; fracture risk; older men; hip fracture |
Year | 2024 |
Journal | Journal of Bone and Mineral Research |
Journal citation | 39 (1), pp. 50-58 |
Publisher | Oxford University Press |
ISSN | 1523-4681 |
Digital Object Identifier (DOI) | https://doi.org/10.1093/jbmr/zjad005 |
PubMed ID | 38630877 |
Scopus EID | 2-s2.0-85190865846 |
PubMed Central ID | PMC11207919 |
Open access | Published as ‘gold’ (paid) open access |
Page range | 50-58 |
Funder | Swedish Government |
Publisher's version | License File Access Level Open |
Output status | Published |
Publication dates | |
Online | 04 Jan 2024 |
Publication process dates | |
Accepted | 01 Dec 2023 |
Deposited | 04 Jun 2025 |
Grant ID | ALFGBG-965744 |
ALFGBG-437971 | |
Additional information | © The Author(s) 2024. Published by Oxford University Press on behalf of the American Society for Bone and Mineral Research. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
https://acuresearchbank.acu.edu.au/item/91y8x/higher-serum-free-thyroxine-levels-are-associated-with-increased-risk-of-hip-fractures-in-older-men
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OA_Svensson_2024_Higher_serum_free_thyroxine_levels_are.pdf | |
License: CC BY 4.0 | |
File access level: Open |
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