ArticleBMJ (Clinical research ed.)2011
Levothyroxine dose and risk of fractures in older adults: nested case-control study.
Article in BMJ (Clinical research ed.), 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
53 citing papers in PubMed, 2 syntheses or guidelines pooled it, 146 citations in OpenAlex.
- Pooled it
- Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement.Thyroid : official journal of the American Thyroid Association · 2014Guideline
- Long-Term Selenium-Yeast Supplementation Does Not Affect Bone Turnover Markers: A Randomized Placebo-Controlled Trial.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2022Trial
- Sex and age-specific medication interaction in osteoporosis risk.GeroScience · 2026Article
- Clinical insights into levothyroxine overdose: A systematic review.World journal of methodology · 2026Article
- Gray-zone decisions in subclinical hypothyroidism: a qualitative analysis of ChatGPT responses.BMC endocrine disorders · 2026Article
- Article
- Research progress of drug-induced osteoporosis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Review
- TSH suppression therapy from an individualized perspective: from mechanism to clinical decision-making.Frontiers in endocrinology · 2026Review
- Thyroid function and cognitive health: rethinking the relationship between "suboptimal" TSH/FT4 levels and cognitive decline.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Article
- Low-Dose Subarachnoid Anesthesia Combined with PENG and FLCN Blocks Reduces Hypotensive Episodes Without Compromising Anesthetic Depth and Duration in Hip Fracture Surgery: A Retrospective Observational Study.Medicina (Kaunas, Lithuania) · 2025Observational
- Fracture risks in patients aged 50 years and older with panhypopituitarism: a nationwide cohort study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Considerations in the Diagnosis and Management of Thyroid Dysfunction in Older Adults.Thyroid : official journal of the American Thyroid Association · 2025Review
- Association between oxidative balance score and thyroid function and all-cause mortality in euthyroid adults.Scientific reports · 2025Article
- The impact of different strategies for modeling associations between medications at low doses and health outcomes: a simulation study and practical application to postpartum opioid use.American journal of epidemiology · 2025Article
- Do Plantar-Flexor Muscle Structure and Function Contribute to Medial Tibial Stress Syndrome in Long-Distance Runners? A Case Report.Journal of athletic training · 2024Article
- Hypothyroidism after hemithyroidectomy: a systematic review and meta-analysis.Thyroid research · 2024Review
- Clearing the Skepticism about Subclinical Hypothyroidism: Is It Beneficial to Treat Patients with Thyroid-Stimulating Hormone >4.5 and <10 mIU/L?Avicenna journal of medicine · 2024Review
- Differentiated thyroid cancer: a focus on post-operative thyroid hormone replacement and thyrotropin suppression therapy.Endocrine · 2024Review
- Evaluation of Bone Health in Postmenopausal Women Using Long-Term Levothyroxine Treatment Due to Post-Procedural Hypothyroidism.International journal of general medicine · 2024Article
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveTo quantify the effect of levothyroxine dose on risk of fractures in older adults.
designNested case-control study.
settingPopulation based health databases, Ontario, Canada.
participantsAdults aged 70 or more prescribed levothyroxine between 1 April 2002 and 31 March 2007 and followed for fractures until 31 March 2008. Cases were cohort members admitted to hospital for any fracture, matched with up to five controls from within the cohort who had not yet had a fracture.
main outcome measurePrimary outcome was fracture (wrist or forearm, shoulder or upper arm, thoracic spine, lumbar spine and pelvis, hip or femur, or lower leg or ankle) in relation to levothyroxine use (current, recent past, remote). Risk among current users was compared between those prescribed high, medium, and low cumulative levothyroxine doses in the year before fracture.
resultsOf 213,511 prevalent levothyroxine users identified, 22,236 (10.4%) experienced a fracture over a mean 3.8 years of follow-up, 18,108 (88%) of whom were women. Compared with remote levothyroxine use, current use was associated with a significantly higher risk of fracture (adjusted odds ratio 1.88, 95% confidence interval 1.71 to 2.05), despite adjustment for numerous risk factors. Among current users, high and medium cumulative doses (>0.093 mg/day and 0.044-0.093 mg/day) were associated with a significantly increased risk of fracture compared with low cumulative doses (<0.044 mg/day): 3.45 (3.27 to 3.65) and 2.62 (2.50 to 2.76), respectively.
conclusionAmong adults aged 70 or more, current levothyroxine treatment was associated with a significantly increased risk of fracture, with a strong dose-response relation. Ongoing monitoring of levothyroxine dose is important to avoid overtreatment in this population.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.