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Aging and disease    2016, Vol. 7 Issue (6) : 734-743     DOI: 10.14336/AD.2016.0325
Original Article |
Low Normal TSH levels are Associated with Impaired BMD and Hip Geometry in the Elderly
Lee Su Jin1,2, Kim Kyoung Min3, Lee Eun Young4, Song Mi Kyung5, Kang Dae Ryong6, Kim Hyeon Chang7, Youm Yoosik8, Yun Young Mi5, Park Hyun-Young9, Kim Chang Oh10, Rhee Yumie1,*
1Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
2Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
3Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
4Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
5Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
6Office of Biostatistics, Ajou University School of Medicine, Suwon, Korea
7Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
8Department of Sociology, Yonsei University, Seoul, Korea
9Division of Cardiovascular and Rare Diseases, Korea National Institute of Health, Osong, Korea
10Division of Geriatrics, Department of Internal Medicine, Severance Hospital, Seoul, Korea
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Subclinical hyperthyroidism is known to be associated with the risk of fractures in elderly people. However, there are few studies assessing whether low normal thyroid-stimulating hormone (TSH) levels affect bone density and geometry. Here, we aimed to assess the influence of the TSH level on bone mineral density (BMD) and geometry in elderly euthyroid subjects. This was a cross-sectional cohort study. A total of 343 men and 674 women with euthyroidism were included and analyzed separately. The subjects were divided into tertiles based on the serum TSH level. The BMD and geometry were measured using dual-energy X-ray absorptiometry and a hip structural analysis program. Multiple regression analysis was used to compute the odds ratios of osteoporosis in the lower TSH tertile group and the association between geometry parameters and the TSH level. We found that the femoral neck and total hip BMDs were lower in the lower TSH tertile group. In women, the cross-sectional area and cortical thickness of the femur were negatively associated with the TSH level in all three regions (the narrow neck, intertrochanter, and femoral shaft); however, in men, these geometry parameters were significantly associated with the TSH level only in the intertrochanter region. The buckling ratio, a bone geometry parameter representing cortical instability, was significantly higher in the lower TSH tertile group in all three regions in women, but not in men. Our results indicated that lower TSH levels in the euthyroid range are related to lower BMD and weaker femoral structure in elderly women.

Keywords TSH      euthyroidism      elderly people      bone density      bone geometry     
Corresponding Authors: Rhee Yumie   
About author:

these authors contributed equally to this work.

Issue Date: 01 December 2016
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Lee Su Jin
Kim Kyoung Min
Lee Eun Young
Song Mi Kyung
Kang Dae Ryong
Kim Hyeon Chang
Youm Yoosik
Yun Young Mi
Park Hyun-Young
Kim Chang Oh
Rhee Yumie
Cite this article:   
Lee Su Jin,Kim Kyoung Min,Lee Eun Young, et al. Low Normal TSH levels are Associated with Impaired BMD and Hip Geometry in the Elderly[J]. Aging and disease, 2016, 7(6): 734-743.
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Figure 1.  The flow chart of the study subjects
Table 1  Clinical characteristics
Table 2  BMD and fracture risk assessment according to the tertiles of TSH
OR95% CIp - valueOR95% CIp - value
1st tertile (TSH1)1.86(1.22 - 2.83)< 0.011.72(0.76 - 3.88)0.19
2nd tertile (TSH2)1.3(0.86 - 1.97)0.350.86(0.35 - 2.09)0.86
3rd tertile (TSH3)Ref.Ref.
Table 3  Odds ratios (ORs) for osteoporosis in the tertile groups of thyroid stimulating hormone (TSH) in euthyroid subjects
CoTh-0.130.002< 0.01-0.0670.0040.24
ITCSA-0.1130.06< 0.01-0.1160.130.04
CoTh-0.140.006< 0.01-0.1180.0110.04
BR0.160.218< 0.010.1140.2540.04
CoTh-0.1380.008< 0.01-0.0320.0140.58
BR0.1420.075< 0.010.0750.0840.22
Table 4  Association between lower TSH tertile and bone geometry parameters in narrow neck, intertrochanter, and femur shaft.
Figure 2.  Bone geometry parameters of the three regions according to the TSH tertiles in women. CSA (A) and CoTh (B) in the NN, IT, and FS were significantly lower in the lower TSH tertile than in the upper TSH tertile. CSMI (C) and Z (D) were not associated with the TSH tertiles, except for Z in IT. BR (E), which indicates cortical instability, showed higher values in the lower TSH tertile. TSH: thyroid-stimulating hormone, CSA: cross-sectional area, CoTh: cortical thickness, CSMI: cross-sectional moment of inertia, Z: section modulus, NN: narrow neck, IT: intertrochanter, FS: femur shaft. Bars indicate the standard deviations. *p < 0.05 by ANOVA
n = 227n = 227n = 220valuen = 112n = 119n = 112value
TSH range(0.36 - 1.17)(1.18 - 1.93)(1.94 - 5.50)(0.36 - 1.05)(1.06 - 1.67)(1.68 - 5.50)
Narrow neck
CSA, cm22.25 ± 0.352.20 ± 0.37†2.24 ± 0.332.31 ± 0.360.012.91 ± 0.482.89 ± 0.492.90 ± 0.442.947 ± 0.520.67
CSMI, cm41.95 ± 0.481.95 ± 0.521.95 ± 0.451.95 ± 0.470.993.29 ± 0.783.26 ± 0.733.29 ± 0.793.312 ± 0.830.89
Z, cm31.07 ± 0.221.06 ± 0.231.08 ± 0.201.08 ± 0.230.611.62 ± 0.331.60 ± 0.311.63 ± 0.311.637 ± 0.360.72
CoTh, cm0.14 ± 0.030.14 ± 0.03†0.14 ± 0.020.15 ± ± 0.030.16 ± 0.030.16 ± 0.030.165 ± 0.030.68
BR13.38 ± 3.4513.99 ± 3.77*†13.15 ± 3.0012.99 ± 3.470.0112.96 ± 3.4313.38 ± 4.4112.84 ± 2.9912.665 ± 2.670.34
CSA, cm23.78 ± 0.683.68 ± 0.69†3.77 ± 0.643.89 ± 0.680.015.10 ± 1.094.97 ± 1.185.129 ± 1.105.19 ± 0.990.34
CSMI, cm49.97 ± 2.599.79 ± 2.709.91 ± 2.5110.23 ± 2.570.1916.47 ± 6.0415.82 ± 6.4716.48 ± 5.6817.10 ± 5.960.32
Z, cm33.19 ± 0.743.11 ± 0.76†3.17 ± 0.713.30 ± 0.730.024.79 ± 1.424.63 ± 1.534.81 ± 1.374.93 ± 1.350.32
CoTh, cm0.31 ± 0.060.30 ± 0.07†0.30 ± 0.06†0.32 ± 0.06<0.010.39 ± 0.090.38 ± 0.100.39 ± 0.080.40 ± 0.080.34
BR10.62 ± 2.4711.10 ± 2.70†10.64 ± 2.2110.12 ± 2.38<0.019.13 ± 2.139.40 ± 2.479.05 ± 2.048.95 ± 1.820.30
Femur shaft
CSA, cm23.59 ± 0.473.51 ± 0.47†3.59 ± 0.463.66 ± 0.46<0.014.73 ± 0.664.71 ± 0.694.72 ± 0.634.77 ± 0.660.76
CSMI, cm43.15 ± 0.613.13 ± 0.613.19 ± 0.613.14 ± 0.610.554.70 ± 0.954.68 ± 0.864.68 ± 0.974.73 ± 1.020.90
Z, cm32.07 ± 0.302.04 ± 0.302.08 ± 0.302.08 ± 0.300.412.85 ± 0.432.84 ± 0.402.85 ± 0.432.86 ± 0.460.93
CoTh, cm0.47 ± 0.090.46 ± 0.09†0.47 ± 0.08†0.49 ± 0.09<0.010.60 ± 0.110.60 ± 0.130.60 ± 0.090.60 ± 0.110.80
BR3.38 ± 0.813.50 ± 0.84†3.42 ± 0.79†3.21 ± 0.76<0.012.85 ± 0.652.91 ± 0.772.83 ± 0.572.81 ± 0.610.51
Supplemental Table 1  Bone geometry parameters according to the thyroid-stimulating hormone (TSH) tertile groups
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