{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:44:21Z","timestamp":1792698261100,"version":"4.5.0"},"reference-count":39,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Clinical hyperthyroidism accelerates bone resorption without compensatory bone formation, reducing bone density and increasing the risk of fracture. The association between subclinical hyperthyroidism and fracture risk is less clear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate the association of endogenous subclinical thyroid dysfunction and fracture risk, independent of clinical confounders.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study included 10\u202f946 participants from the Atherosclerosis Risk in Communities Study, an ongoing prospective cohort study of community-dwelling individuals conducted from 1987-1989 through December 31, 2019, in Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and the suburbs of Minneapolis, Minnesota. Participants were not taking thyroid medications and had no history of fractures.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Thyrotropin and free thyroxine levels were measured at visit 2 (1990-1992). Subclinical hyperthyroidism was defined as a thyrotropin level lower than 0.56 mIU\/L, subclinical hypothyroidism as a thyrotropin level higher than 5.1 mIU\/L, and euthyroidism as a thyrotropin level of 0.56 to 5.1 mIU\/L, with normal free thyroxine levels from 0.85 to 1.4 ng\/dL.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Incident fracture was ascertained using hospitalization discharge codes through 2019 and linkage to inpatient and outpatient Medicare claims through 2018.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 10\u202f946 participants (54.3% women; mean [SD] age, 57 [5.7] years), 93.0% had euthyroidism, 2.6% had subclinical hyperthyroidism, and 4.4% had subclinical hypothyroidism. During a median follow-up of 21 years (IQR, 13.0-27.3 years), there were 3556 incident fractures (167.1 per 10\u202f000 person-years). The adjusted hazard ratios of fracture were 1.34 (95% CI, 1.09-1.65) for those with subclinical hyperthyroidism and 0.90 (95% CI, 0.77-1.05) for those with subclinical hypothyroidism compared with individuals with euthyroidism. Among those with normal free thyroxine levels, thyrotropin levels in the lower-than-normal range were significantly associated with higher fracture-related hospitalization risk; fracture risk was greater among individuals with thyrotropin concentrations below 0.56 mIU\/L.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This community-based cohort study suggests that subclinical hyperthyroidism was an independent risk factor associated with fracture. The increased risk for fracture among individuals with a thyrotropin level lower than 0.56 mIU\/L highlights a potential role for more aggressive screening and monitoring of patients with subclinical hyperthyroidism to prevent bone mineral disease.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.40823","type":"journal-article","created":{"date-parts":[[2022,11,8]],"date-time":"2022-11-08T11:20:14Z","timestamp":1667906414000},"page":"e2240823","source":"Crossref","is-referenced-by-count":17,"title":["Association Between Subclinical Thyroid Dysfunction and Fracture Risk"],"prefix":"10.1001","volume":"5","author":[{"given":"Natalie R.","family":"Daya","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Fretz","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California, 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