Rizik od preloma kostiju u osoba sa subkliničkim poremećajem funkcije štitaste žlezde

Abstract

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.