Study on the Relationship between Relevant Indicators in Postmenopausal Women with Subclinical Hypothyroidism and Bone Mineral Density

doi:10.12114/j.issn.1007-9572.2025.0406

Chinese General Practice ›› 2026, Vol. 29 ›› Issue (26): 3774-3780.DOI: 10.12114/j.issn.1007-9572.2025.0406

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Study on the Relationship between Relevant Indicators in Postmenopausal Women with Subclinical Hypothyroidism and Bone Mineral Density

1. The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang 561113, China
2. Health Management Center, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
3. Development Planning Department, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China

Received:2025-07-13 Revised:2026-01-21 Published:2026-09-15 Online:2026-08-11
Contact: RAN Limei

绝经后亚临床甲状腺功能减退症体检女性相关指标与骨密度的关系研究

1．561113　贵州省贵阳市，贵州医科大学公共卫生与健康学院环境污染与疾病监控教育部重点实验室
2．550004　贵州省贵阳市，贵州医科大学附属医院健康管理中心
3．550004　贵州省贵阳市，贵州医科大学附属医院发展规划处

通讯作者: 冉利梅
作者简介:
作者贡献：
冯绍会、冉利梅进行文章的构思与研究的设计；冯绍会、朱焱负责研究的实施；冯绍会、朱玲龑、宋可心负责数据收集；冯绍会进行数据分析与结果解释，撰写论文；朱玲龑、吴燕玲、吴汶璟、张丹丹负责相关行政或技术支持；冉利梅负责文章的质量控制与审校、研究经费的获取及论文写作的指导，对文章整体负责。
基金资助:
贵阳市科技计划项目(筑科合同[2022]-4-2-1); 贵州医科大学附属医院院内课题项目(2021-GMHCT-011)

Abstract

Abstract:

Background

Previous studies have demonstrated an inverse association between subclinical hypothyroidism and osteoporosis (OP) risk in postmenopausal women. However, the precise effects of subclinical hypothyroidism on bone mineral density and its specific sites of action remain inconclusive.

Objective

To study the relationship between thyroid function indicators and bone mineral density at different sites in premenopausal and postmenopausal patients with subclinical hypothyroidism, and to explore predictive factors for osteoporosis.

Methods

A study was conducted on 591 women aged 40-60 years with subclinical hypothyroidism who underwent physical examinations at the Health Management Center of Guizhou Medical University Affiliated Hospital between 2023 and 2024. Participants were categorized by menopausal status into premenopausal women (n=189) and postmenopausal women (n=402). Serum levels of free triiodothyronine (FT₃), free thyroxine (FT₄), thyroid-stimulating hormone (TSH), aspartate aminotransferase (AST), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). Bone mineral density (BMD) was measured at the lumbar spine, femoral neck and total hip in both groups. Pearson correlation analysis and multiple linear regression analysis were employed to investigate the correlation between thyroid indicators and bone density at various sites. Receiver operating characteristic (ROC) curves were plotted to explore the predictive value of FT₃ for osteoporosis in postmenopausal women.

Results

Pearson correlation analysis revealed that FT₃, FT₄, AST and age were negatively correlated with lumbar spine bone mineral density (P<0.05); age, FT₄, AST, TC and LDL-C were negatively correlated with femoral neck bone mineral density (P<0.05); age, FT₄ and HDL-C were negatively correlated with total hip bone mineral density (P<0.05); height, body weight and BMI were positively correlated with lumbar spine, femoral neck and total hip bone mineral density (P<0.05). Multivariate linear regression analysis revealed that FT₃ (β=-0.120, P<0.05), body weight (β=0.267, P<0.05), and age (β=-0.401, P<0.05) were significant predictors of lumbar spine bone density in female examinees overall; FT₃ (β=-0.161, P<0.05), body weight (β=0.201, P<0.05), and age (β=-0.235, P<0.05) were factors influencing lumbar spine bone density in postmenopausal women; FT₃ was not associated with femoral neck or total hip bone mineral density in premenopausal women, postmenopausal women, or the overall female cohort (P>0.05); FT₄ was not associated with bone mineral density at any site in premenopausal women, postmenopausal women, or the overall female cohort (P>0.05). ROC curve analysis revealed that FT₃ predicted lumbar osteoporosis in postmenopausal women with an area under the curve (AUC) of 0.609 (95%CI=0.523-0.696), sensitivity of 69.2%, specificity of 51.0%, and optimal cutoff value of 4.605 pmol/L.

Conclusion

FT₃ is a significant factor influencing lumbar spine bone mineral density in postmenopausal women with subclinical hypothyroidism, with subclinical hypothyroidism. A level of 4.605 pmol/L represents the optimal cutoff value for FT₃ in predicting lumbar osteoporosis in this population, providing a reference indicator for preliminary screening of lumbar OP risk.

Key words: Subclinical hypothyroidism, Premenopausal, Postmenopausal, Osteoporosis, Bone density, FT₃

摘要：

背景

既往研究表明绝经后妇女亚临床甲状腺功能减退症与骨质疏松症（OP）风险呈负相关，但亚临床甲状腺功能减退症对骨密度的影响及作用部位尚未形成明确结论。

目的

研究绝经前及绝经后亚临床甲状腺功能减退症患者甲状腺功能指标与不同部位骨密度的关系，探讨OP的预测因子。

方法

选取2023—2024年于贵州医科大学附属医院健康管理中心进行体检的591例40~60岁亚临床甲状腺功能减退症女性为研究对象，按绝经状态将其划分为绝经前女性（n=189）和绝经后女性（n=402）。检测记录受试者血清游离三碘甲状腺原氨酸（FT₃）、游离甲状腺素（FT₄）、促甲状腺激素（TSH）、天冬氨酸氨基转移酶（AST）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）等生化指标，测量两组受试者腰椎、股骨颈和全髋骨密度。采用Pearson相关分析和多元线性回归分析探究甲状腺指标与各部位骨密度的相关性；绘制受试者工作特征（ROC）曲线，探究FT₃在绝经后女性OP预测中的应用价值。

结果

Pearson相关分析结果表明，FT₃、FT₄、AST及年龄与腰椎骨密度呈负相关（P<0.05）；年龄、FT₄、AST、TC、LDL-C与股骨颈骨密度呈负相关（P<0.05）；年龄、FT₄、HDL-C与全髋骨密度呈负相关（P<0.05）；身高、体质量、BMI与腰椎、股骨颈、全髋骨密度呈正相关（P<0.05）。多元线性回归分析结果显示，FT₃（β=-0.120，P<0.05）、体质量（β=0.267，P<0.05）、年龄（β=-0.401，P<0.05）是总体检女性腰椎骨密度的影响因素；FT₃（β=-0.161，P<0.05）、体质量（β=0.201，P<0.05）、年龄（β=-0.235，P<0.05）是绝经后女性腰椎骨密度的影响因素；FT₃与绝经前女性、绝经后女性及总体检女性股骨颈和全髋骨密度无关（P>0.05）；FT₄与绝经前女性、绝经后女性及总体检女性各部位骨密度无关（P>0.05）。ROC曲线分析结果表明，FT₃预测绝经后亚临床甲状腺功能减退症女性腰椎OP的ROC曲线下面积为0.609（95%CI=0.523~0.696），灵敏度为69.2%，特异度为51.0%，最佳截断值为4.605 pmol/L。

结论

FT₃是绝经后亚临床甲状腺功能减退症患者腰椎骨密度的影响因素，4.605 pmol/L是FT₃预测绝经后亚临床甲状腺功能减退症患者腰椎OP的最佳截断值，为该人群腰椎OP风险的初步筛查提供了参考指标。

关键词: 亚临床甲状腺功能减退症, 绝经前, 绝经后期, 骨质疏松, 骨密度, FT₃

CLC Number:

R 581.2

FENG Shaohui,ZHU Lingyan,SONG Kexin, et al. Study on the Relationship between Relevant Indicators in Postmenopausal Women with Subclinical Hypothyroidism and Bone Mineral Density[J]. Chinese General Practice, 2026, 29(26): 3774-3780. DOI: 10.12114/j.issn.1007-9572.2025.0406.
冯绍会,朱玲龑,宋可心等. 绝经后亚临床甲状腺功能减退症体检女性相关指标与骨密度的关系研究[J]. 中国全科医学, 2026, 29(26): 3774-3780. DOI: 10.12114/j.issn.1007-9572.2025.0406.

Figures/Tables 4

References 25

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人体测量和生化指标	绝经前女性（n=189）	绝经后女性（n=402）	t值	P值
年龄（岁）	46.9±3.7	54.9±3.4	-26.058	<0.001
身高（cm）	156.5±5.6	154.5±5.4	4.045	<0.001
体质量（kg）	58.9±9.0	56.7±7.4	2.960	0.003
BMI（kg/m²）	24.1±3.6	23.7±3.0	1.085	0.279
SBP（mmHg）	120±16	124±17	-2.985	0.003
DBP（mmHg）	73±11	75±11	-2.423	0.016
TSH（mU/L）	6.04±2.72	6.06±4.58	-0.052	0.958
FT₃（pmol/L）	4.53±0.53	4.64±0.50	-2.341	0.020
FT₄（pmol/L）	15.32±1.65	15.76±1.84	-2.758	0.006
ALT（U/L）	18.61±11.15	21.20±10.58	-2.728	0.007
AST（U/L）	20.60±6.69	22.90±6.14	-4.125	<0.001
Cr（μmol/L）	59.16±6.53	59.86±7.18	-1.126	0.261
TC（mmol/L）	4.90±0.77	5.29±0.90	-5.110	<0.001
TG（mmol/L）	1.61±1.30	1.77±1.61	-1.235	0.217
HDL-C（mmol/L）	1.48±0.35	1.50±0.37	-0.866	0.387
LDL-C（mmol/L）	2.99±0.69	3.26±0.78	-4.055	<0.001
腰椎BMD（g/cm²）	1.169±0.159	1.004±0.143	12.547	<0.001
股骨颈BMD（g/cm²）	0.915±0.110	0.808±0.110	11.038	<0.001
全髋BMD（g/cm²）	0.981±0.122	0.879±0.123	9.390	<0.001

人体测量和生化指标	绝经前女性（n=189）	绝经后女性（n=402）	t值	P值
年龄（岁）	46.9±3.7	54.9±3.4	-26.058	<0.001
身高（cm）	156.5±5.6	154.5±5.4	4.045	<0.001
体质量（kg）	58.9±9.0	56.7±7.4	2.960	0.003
BMI（kg/m²）	24.1±3.6	23.7±3.0	1.085	0.279
SBP（mmHg）	120±16	124±17	-2.985	0.003
DBP（mmHg）	73±11	75±11	-2.423	0.016
TSH（mU/L）	6.04±2.72	6.06±4.58	-0.052	0.958
FT₃（pmol/L）	4.53±0.53	4.64±0.50	-2.341	0.020
FT₄（pmol/L）	15.32±1.65	15.76±1.84	-2.758	0.006
ALT（U/L）	18.61±11.15	21.20±10.58	-2.728	0.007
AST（U/L）	20.60±6.69	22.90±6.14	-4.125	<0.001
Cr（μmol/L）	59.16±6.53	59.86±7.18	-1.126	0.261
TC（mmol/L）	4.90±0.77	5.29±0.90	-5.110	<0.001
TG（mmol/L）	1.61±1.30	1.77±1.61	-1.235	0.217
HDL-C（mmol/L）	1.48±0.35	1.50±0.37	-0.866	0.387
LDL-C（mmol/L）	2.99±0.69	3.26±0.78	-4.055	<0.001
腰椎BMD（g/cm²）	1.169±0.159	1.004±0.143	12.547	<0.001
股骨颈BMD（g/cm²）	0.915±0.110	0.808±0.110	11.038	<0.001
全髋BMD（g/cm²）	0.981±0.122	0.879±0.123	9.390	<0.001

指标	腰椎BMD		股骨颈BMD		全髋BMD
指标	r值	P值	r值	P值	r值	P值
年龄	-0.445	<0.001	-0.420	<0.001	-0.342	<0.001
身高	0.233	<0.001	0.237	<0.001	0.143	0.001
体质量	0.305	<0.001	0.315	<0.001	0.333	<0.001
BMI	0.199	<0.001	0.206	<0.001	0.277	<0.001
SBP	-0.056	0.174	-0.074	0.074	-0.038	0.360
DBP	-0.014	0.734	-0.035	0.397	-0.011	0.794
TSH	-0.010	0.809	-0.040	0.329	-0.046	0.268
FT₃	-0.143	0.001	-0.091	0.027	-0.043	0.295
FT₄	-0.130	0.001	-0.147	<0.001	-0.147	<0.001
ALT	-0.014	0.730	-0.052	0.206	0.028	0.502
AST	-0.087	0.034	-0.136	0.001	-0.060	0.142
Cr	0.041	0.319	0.026	0.524	0.016	0.705
TC	-0.077	0.060	-0.089	0.030	-0.035	0.399
TG	-0.018	0.671	0.0230	0.575	0.052	0.207
HDL-C	-0.039	0.348	-0.063	0.126	-0.115	0.005
LDL-C	-0.073	0.076	-0.098	0.017	-0.035	0.395

指标	腰椎BMD		股骨颈BMD		全髋BMD
指标	r值	P值	r值	P值	r值	P值
年龄	-0.445	<0.001	-0.420	<0.001	-0.342	<0.001
身高	0.233	<0.001	0.237	<0.001	0.143	0.001
体质量	0.305	<0.001	0.315	<0.001	0.333	<0.001
BMI	0.199	<0.001	0.206	<0.001	0.277	<0.001
SBP	-0.056	0.174	-0.074	0.074	-0.038	0.360
DBP	-0.014	0.734	-0.035	0.397	-0.011	0.794
TSH	-0.010	0.809	-0.040	0.329	-0.046	0.268
FT₃	-0.143	0.001	-0.091	0.027	-0.043	0.295
FT₄	-0.130	0.001	-0.147	<0.001	-0.147	<0.001
ALT	-0.014	0.730	-0.052	0.206	0.028	0.502
AST	-0.087	0.034	-0.136	0.001	-0.060	0.142
Cr	0.041	0.319	0.026	0.524	0.016	0.705
TC	-0.077	0.060	-0.089	0.030	-0.035	0.399
TG	-0.018	0.671	0.0230	0.575	0.052	0.207
HDL-C	-0.039	0.348	-0.063	0.126	-0.115	0.005
LDL-C	-0.073	0.076	-0.098	0.017	-0.035	0.395

指标	腰椎BMD					股骨颈BMD					全髋BMD
指标	B	SE	β	t值	P值	B	SE	β	t值	P值	B	SE	β	t值	P值
总体检女性
年龄	-0.013	0.001	-0.401	-10.715	<0.001	-0.009	0.001	-0.361	-9.546	<0.001	-0.008	0.001	-0.320	-8.161	<0.001
身高	0.001	0.001	0.045	1.114	0.266	0.001	0.001	0.059	1.448	0.148	-0.001	0.001	-0.023	-0.555	0.579
体质量	0.006	0.001	0.267	6.544	<0.001	0.004	0.001	0.261	6.331	<0.001	0.005	0.001	0.298	6.979	<0.001
FT₃	-0.039	0.012	-0.120	-3.191	0.001	-0.014	0.009	-0.059	-1.549	0.122	-0.008	0.010	-0.031	-0.778	0.437
FT₄	-0.002	0.003	-0.024	-0.649	0.516	-0.004	0.003	-0.056	-1.505	0.133	-0.005	0.003	-0.065	-1.665	0.096
绝经前女性
年龄	-0.003	0.003	-0.058	-0.794	0.428	-0.001	0.002	-0.028	-0.387	0.699	0.001	0.002	0.020	0.296	0.768
身高	-0.001	0.002	-0.052	-0.687	0.493	-0.002	0.001	-0.096	-1.282	0.201	-0.004	0.002	-0.166	-2.316	0.022
体质量	0.006	0.001	0.365	4.626	<0.001	0.005	0.001	0.377	4.856	<0.001	0.006	0.001	0.478	6.402	<0.001
FT₃	-0.027	0.023	-0.090	-1.144	0.254	-0.002	0.016	-0.011	-0.146	0.884	-0.005	0.017	-0.022	-0.289	0.773
FT₄	0.005	0.007	0.052	0.686	0.494	-0.002	0.005	-0.024	-0.318	0.751	-0.003	0.005	-0.041	-0.567	0.572
绝经后女性
年龄	-0.010	0.002	-0.235	-5.003	<0.001	-0.008	0.002	-0.239	-5.086	<0.001	-0.008	0.002	-0.214	-4.420	<0.001
身高	0.003	0.001	0.101	1.922	0.055	0.003	0.001	0.133	2.541	0.011	0.001	0.001	0.045	0.828	0.408
体质量	0.004	0.001	0.201	3.745	<0.001	0.003	0.001	0.192	3.586	<0.001	0.003	0.001	0.182	3.284	0.001
FT₃	-0.045	0.014	-0.161	-3.314	0.001	-0.019	0.010	-0.086	-1.771	0.077	-0.010	0.012	-0.042	-0.828	0.408
FT₄	-0.005	0.004	-0.066	-1.383	0.167	-0.005	0.003	-0.086	-1.806	0.072	-0.006	0.003	-0.083	-1.692	0.091

Study on the Relationship between Relevant Indicators in Postmenopausal Women with Subclinical Hypothyroidism and Bone Mineral Density

绝经后亚临床甲状腺功能减退症体检女性相关指标与骨密度的关系研究

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