폐경 여성에서 갑상선 기능과 골밀도의 연관성
The Infl uence of Thyroid Function on Bone Mineral Density in Korean Postmenopausal Women
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초록
연구목적: 골다공증은 가장 흔한 대사성 질환 중의 하나로, 연령이 증가함에 따라 골량이 감소하고 골의 미세구조 변화로 인한 골의 강도가 약화되어 골절의 위험성이 증가되는 전신성 골격계 질환이다. 최근 갑상선 호르몬이 골밀도와 연관성에 대한 보고가 있는데, 갑상선 자극호르몬이 낮은 경우 골밀도가 낮으며 티록신이 높을수록 골밀도는 낮아진다는 보고도 있다. 따라서 한국 폐경 여성에서 갑상선 질환이나 갑상선 기능의 변화가 골밀도에 미치는 영향을 알아보고자 본 연구가 진행되었다. 연구재료 및 방법: 서울 소재 8개 대학병원의 건강검진 센터에서 검진을 한 2,279명의 폐경 후 여성의 의무기록과 신장, 체중, 골밀도와 갑상선 기능검사결과를 조사하였다. 모든 자료는 SPSS 로 분석하여 그 유의성을 검증하였다. 결과: 다기관에서 조사한 비교적 대규모 수의 폐경 여성을 대상으로 한 본 연구에서 갑상선 기능 검사 중 혈청트리요오드사이로닌과 티록신은 골밀도와 연관성이 있으며 갑상선 자극호르몬은 유의한 연관성이 없었다. 이러한 연관성은 연령을 보정한 후에는 유의하지 않아 혈청 트리요오드사이로닌과 티록신의 골밀도 연관성은 연령에 따른 변화에 의한 것으로 추정된다. 갑상선 질환의 유무에 따라 요추 골밀도와 대퇴골 및 total hip 골밀도의 평균값은 차이가 없었다. 갑상선 자극호르몬이 0.5 mU/L 미만인 group에서 갑상선 자극호르몬이 정상이거나 증가된 그룹보다 골감소증이 유의하게 높았다. 결론: 한국 폐경 여성에서 갑상선 기능과 골밀도는 연관성이 있었다.
Abstract
Objectives: Osteoporosis, defined as decreased bone mass and structural deterioration of bone, increases the incidence of fractures. Recently, there have been reports suggesting that thyroid hormones are related to bone mineral density (BMD). It has been reported that low normal circulating thyrotropin (TSH) levels correlate with lower BMD and that thyroxine (T4) and bone density are negatively related. This research aims to examine the relationship between BMD and thyroid diseases and other functional changes in postmenopausal women. Methods: The medical records of 2,279 postmenopausal women who attended the health care clinic in eight university hospitals between March 2001 and December 2007 were reviewed retrospectively. We determined the baseline characteristics of the women, including age, height, weight, and body mass index (BMI). The BMD was measured by dual-energy X-ray absorptiometry (DEXA). The correlation between the thyroid status and BMD was analyzed using the SPSS 12.0 program. Results: This research used data from a relatively large number of postmenopausal women gathered in a multicenter approach. Of the thyroid functional tests, thyroid stimulating hormone (triiodothyronine or T3) and T4 correlated with BMD, while free T4and TSH did not show a statistically signifi cant correlation. After adjusted age, thyroid function test did not correlate with BMD. Osteopenia was signifi cantly higher in the group with TSH below 0.5 mU/L compared with groups that had normal or high TSH. There was no statistically significant difference in lumbar BMD and total hip BMD among patients with thyroid diseases and healthy patients. Conclusion: The level of T3 and T4 correlated well with BMD in Korean post-menopausal women.
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