ArticleFrontiers in endocrinology2026
Thyroid hormones and thyroid hormone sensitivity indices correlate with volumetric bone mineral density and vertebral fracture risk among the osteoporotic population in northern China.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Thyroid hormones play critical roles in regulating bone turnover and maintaining bone mass. However, the relationship among thyroid hormones, their sensitivity indices, bone mineral density (BMD) and fracture risk remained unclear in the Chinese osteoporotic population. This study aimed to investigate the associations between thyroid hormones, their sensitivity indices, and both volumetric BMD (measured by quantitative computed tomography, QCT-BMD), areal BMD (measured by dual-energy X-ray absorptiometry, DXA BMD), as well as the risk of vertebral fractures, among primary osteoporotic individuals aged over 50 years old of euthyroid adults in northern China (north of the Yellow River). Methods: A total of 1, 386 men and postmenopausal women (aged ≥50 years) with euthyroidism and primary osteoporosis were recruited from Beijing Jishuitan Hospital during January 2021 to December 2024. Participants were divided into two groups: those without vertebral fractures (n = 856) and those with vertebral fractures (n = 530). Demographic characteristics, serum bone turnover markers (ALP, tP1NP, β-CTX, OC, PTH), thyroid hormones (TT4, TT3, TSH, FT3, FT4), thyroid hormone sensitivity indices (FT4/FT3, TSHI, TT4RI, TFQI), lumbar QCT-BMD, lumbar DXA-BMD, and total hip DXA-BMD were compared between groups. Univariate and multivariate logistic regression analyses, restricted cubic spline (RCS) regression, and subgroup analyses were performed to evaluate the independent effects of thyroid hormones and their sensitivity indices on BMD measures and vertebral fracture risk, adjusting for potential confounders including age, sex, BMI, smoking, alcohol consumption, diabetes, hypertension, and hyperlipidemia. Results: The vertebral fracture group exhibited significantly higher TT3 levels compared to the non-fracture group (TT3: 1.98 [1.60, 2.89] vs. 1.76 [1.50, 1.91] nmol/L, Conclusion: Our findings demonstrated that thyroid hormones-specifically FT3, TT3, TSH-and the peripheral thyroid hormone sensitivity index FT4/FT3 were more strongly associated with vertebral fracture risk and bone mineral density. Notably, these associations were more pronounced with vBMD measured by QCT. Collectively, these results highlighted the potential role of FT3, TT3, TSH, and the peripheral thyroid sensitivity index FT4/FT3 as indicators of bone mass and fracture risk prediction in this population.
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