Association of subclinical thyroid dysfunction with the risk of vertebral fracture: a meta-analysis of prospective cohort studies

Subclinical thyroid dysfunction (STD) is associated with an elevated risk of non-vertebral fractures. However, whether STD is associated with the risk of vertebral fracture remains controversial. This study aimed to determine the relationship between STD and the risk of vertebral fracture using a meta-analysis approach.
PubMed, Embase, and the Cochrane Library databases were searched for eligible studies published until March 01, 2025. Only prospective cohort studies that reported effect estimates with 95% confidence intervals (CIs) of vertebral fractures in participants with subclinical hyperthyroidism (SCH) and subclinical hypothyroidism (SH) compared to those with euthyroidism were included. A random-effects model was used to pool risk ratios (RRs), and analyses accounted for key covariates, including demographic factors, lifestyle variables, and disease history where reported.
Ten prospective cohort studies involving 61,219 individuals were included in this meta-analysis. SCH was associated with an increased risk of vertebral fracture (RR: 2.20; 95% CI: 1.60–3.02; p < 0.001). Moreover, the risk of vertebral fracture in individuals with SH was higher than that in those with euthyroidism (RR, 1.22; 95% CI: 1.01–1.49; p = 0.044). The pooled conclusions for the association between SCH and vertebral fracture risk were robust, whereas the significant association between SH and vertebral fracture was variable. The relationship between SH and vertebral fracture risk was affected by the median age of individuals (p = 0.047).
Our study found that SCH was an independent risk factor for vertebral fracture, and that SH may increase the risk of vertebral fracture. Clinically, these findings support the need for regular monitoring of thyroid function, particularly in older adults, to identify individuals with STD who may benefit from targeted interventions to reduce vertebral fracture risk.
We performed a systematic review and meta-analysis of prospective cohort studies to determine the relationship between subclinical thyroid dysfunction and risk of vertebral fractures.
Subclinical hyperthyroidism (SCH) and hypothyroidism (SH) are associated with an elevated risk of vertebral fractures.
The association between SCH and the risk of vertebral fracture was robust, whereas the median age of participants could affect the association between SH and the risk of vertebral fracture.

亚临床甲状腺功能异常（subclinical thyroid dysfunction, STD）与非椎体骨折风险升高相关。然而，其与椎体骨折风险的关联仍存在争议。本研究旨在通过荟萃分析方法，明确亚临床甲状腺功能异常与椎体骨折风险之间的关联。
本研究检索了截至2025年3月1日发表于PubMed、Embase及Cochrane Library数据库的符合纳入标准的研究。仅纳入对比亚临床甲状腺功能亢进症（subclinical hyperthyroidism, SCH）、亚临床甲状腺功能减退症（subclinical hypothyroidism, SH）参与者与甲状腺功能正常者椎体骨折效应值及95%置信区间（confidence interval, CI）的前瞻性队列研究。采用随机效应模型合并风险比（risk ratio, RR），并对研究报告的人口统计学因素、生活方式变量及疾病史等关键混杂因素进行校正分析。
本荟萃分析共纳入10项前瞻性队列研究，涉及61219名受试者。结果显示，亚临床甲状腺功能亢进症（SCH）与椎体骨折风险升高相关（风险比：2.20；95%置信区间：1.60~3.02；p < 0.001）。此外，亚临床甲状腺功能减退症（SH）参与者的椎体骨折风险亦高于甲状腺功能正常者（风险比：1.22；95%置信区间：1.01~1.49；p = 0.044）。SCH与椎体骨折风险的合并关联结果稳健可靠，而SH与椎体骨折的显著关联则存在变异性。亚临床甲状腺功能减退症与椎体骨折风险的关联受受试者中位年龄影响（p = 0.047）。
本研究发现，SCH是椎体骨折的独立危险因素，而SH或可升高椎体骨折风险。临床实践中，本研究结果支持需定期监测甲状腺功能，尤其在老年人群中，以识别亚临床甲状腺功能异常患者，并为其提供针对性干预措施以降低椎体骨折风险。
本研究针对前瞻性队列研究开展了系统综述与荟萃分析，旨在明确亚临床甲状腺功能异常与椎体骨折风险之间的关联。
亚临床甲状腺功能亢进症（SCH）与亚临床甲状腺功能减退症（SH）均与椎体骨折风险升高相关。
SCH与椎体骨折风险的关联稳健可靠，而受试者中位年龄可影响SH与椎体骨折风险之间的关联。