| Summary: | Background/Aim. The Fracture Risk Assessment Tool (FRAX® score) is the
10-year estimated risk calculation tool for bone fracture that includes
clinical data and hip bone mineral density measured by dual-energy x-ray
absorptiometry (DXA). The aim of this cross-sectional study was to elucidate
the ability of the FRAX® score in discriminating between bone fracture
positive and negative pre- and post-menopausal women with subclinical
hyperthyroidism. Methods. The bone mineral density (by DXA), thyroid
stimulating hormone (TSH) level, free thyroxine (fT4) level, thyroid
peroxidase antibodies (TPOAb) titre, osteocalcin and beta-cross-laps were
measured in 27 pre- and post-menopausal women with newly discovered
subclinical hyperthyroidism [age 58.85 ± 7.83 years, body mass index (BMI)
27.89 ± 3.46 kg/m2, menopause onset in 46.88 ± 10.21 years] and 51 matched
euthyroid controls (age 59.69 ± 5.72 years, BMI 27.68 ± 4.66 kg/m2, menopause
onset in 48.53 ± 4.58 years). The etiology of subclinical hyperthyroisims was
autoimmune thyroid disease or toxic goiter. FRAX® score calculation was
performed in both groups. Results. In the group with subclinical
hyperthyroidism the main FRAX® score was significantly higher than in the
controls (6.50 ± 1.58 vs 4.35 ± 1.56 respectively; p = 0.015). The FRAX®
score for hip was also higher in the evaluated group than in the controls
(1.33 ± 3.92 vs 0.50 ± 0.46 respectively; p = 0.022). There was no
correlations between low TSH and fracture risk (p > 0.05). The ability of
the FRAX® score in discriminating between bone fracture positive and negative
pre- and postmenopausal female subjects (p < 0.001) is presented by the area
under the curve (AUC) plotted via ROC analysis. The determined FRAX score
cut-off value by this analysis was 6%, with estimated sensitivity and
specificity of 95% and 75.9%, respectively. Conclusion. Pre- and
postmenopausal women with subclinical hyperthyroidism have higher FRAX®
scores and thus greater risk for low-trauma hip fracture than euthyroid
premenopausal women. Our results point to the use of FRAX® calculator in
monitoring pre- and postmenopausal women with subclinical hyperthyroidism to
detect subjects with high fracture risk in order to prevent further
fractures.
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