背景:这项研究的目的是总结以前的研究结果,标准化数据,并提出了新的统计结果,以便为医生提供有关血清TSH浓度与骨矿物质密度(BMD)之间关联的临床显着结果。
方法:要进行这项总括审查,进行了系统的搜索,其中主要的在线医疗数据库,比如PubMed,WebofScience,Embase,Scopus,科克伦图书馆,和谷歌学者,检索有关TSH对骨密度影响的荟萃分析和系统评价。此外,对所有主要研究进行了统计分析筛选.
结果:本研究的统计结果基于75,898名患者的数据。亚临床甲状腺功能亢进症患者任何类型骨折的合并风险比估计为1.36(95%CI:1.18-1.56;p<0.001)。接受L-甲状腺素抑制治疗的男性患者桡骨远端BMD的SMD估计为-0.61(95%CI:-1.10-(-0.11);p=0.02)。此外,在接受L-甲状腺素抑制治疗的患者中,任何骨折的合并风险比估计为1.98(95%CI:0.98~3.98;p=0.06).在这些患者中,BMD可能与未治疗的患者有显著差异.然而,差异取决于骨骼的类型。
结论:我们的数据证实亚临床甲状腺功能亢进症对骨骼有不利影响,导致BMD下降。根据获得的结果,作者认为,TSH血清水平降低本身可能是与BMD降低相关的个体因素,因此,骨折的风险更大。然而,应该注意的是,TSH抑制治疗的效果在评估BMD的感兴趣区域之间是不同的.此外,结果表明,这个问题可能,在特定领域,不仅涉及绝经后妇女,也涉及男性患者。这些结论应有助于仔细考虑TSH抑制疗法在所有患者中的应用。DTC术后应特别注意患者,而实施L-甲状腺素治疗的所有利弊都应单独考虑。
BACKGROUND: The aim of this study was to summarize the results of previous studies, standardize the data, and present new statistical results in order to provide physicians with clinically significant outcomes regarding the association between serum TSH concentration and bone mineral density (BMD).
METHODS: To perform this umbrella review, a systematic search was conducted in which major online medical databases, such as PubMed, Web of Science, Embase, Scopus, Cochrane Library, and Google Scholar, were searched for meta-analyses and systematic reviews regarding the effect of TSH on BMD. Furthermore, all primary studies were screened for statistical analysis.
RESULTS: The statistical outcomes of the present study were based on the data of 75,898 patients. The pooled risk ratio of any kind of fracture in patients with subclinical hyperthyroidism was estimated to be 1.36 (95% CI: 1.18-1.56; p < 0.001). The SMD for BMD in the distal radius in male patients receiving L-thyroxine suppression therapy was estimated to be -0.61 (95% CI: -1.10-(-0.11); p = 0.02). Furthermore, the pooled risk ratio of any fracture in patients receiving L-thyroxine suppression therapy was estimated to be 1.98 (95% CI: 0.98 - 3.98; p = 0.06). In these patients, the BMD may significantly differ from that in non-treated patients. However, the difference depends on the type of bone.
CONCLUSIONS: Our data confirmed that subclinical hyperthyroidism has a detrimental effect on bones, causing decreased BMD. Based on the obtained results, the authors suggest that a reduced TSH serum level itself may be an individual factor associated with decreased BMD and, thus, with a greater risk of bone fracture. Nevertheless, it should be noted that the effects of TSH suppression therapy differ between areas of interest for assessing BMD. Furthermore, the results have shown that this issue may, in specific areas, concern not only postmenopausal women but also male patients. These conclusions should contribute to a careful consideration of the application of TSH suppressive therapy in all patients. Particular attention should be given to patients after DTC, while all the advantages and disadvantages of implementing L-thyroxine therapy should be individually considered.