老年2型糖尿病患者合并骨质疏松的相关因素分析

Risk factors of osteoporosis in elderly type 2 diabetic patients

目的观察老年2型糖尿病（T2DM）患者的骨密度改变，并分析其与骨代谢及糖脂代谢等生化指标水平的相关性。方法选择60岁以上T2DM患者202例（男性102例，女性100例），采用双能X线骨密度仪测定患者腰椎、股骨颈及全髋骨密度，按T值不同分为3个亚组：骨密度正常组188例、骨量减少组71例、骨质疏松组43例。并测定糖脂代谢、骨代谢相关指标，并比较各组间差异。结果男性患者中，骨质疏松组患者的糖尿病病程（F＝4.184，P＝0.018）、尿酸（F ＝4.101，P＝0.019）及25-（OH）D（F ＝5.712，P＝0.004）水平低于其余两组，糖化血红蛋白（F ＝3.621，P＝0.030）水平明显高于其余两组。女性患者中，骨质疏松组患者的体质指数（F ＝8.056，P＝0.001）、总胆固醇（F ＝4.787，P＝0.011）低于其余两组，三酰甘油（F ＝3.502，P＝0.034）及骨钙素（F＝3.724，P＝0.028）水平高于其余两组。Logistic回归分析结果显示，男性T2DM患者合并骨质疏松与糖尿病病程较长（β＝－0.059，P＝0.044）、低血尿酸水平（β＝0.006，P＝0.012）等因素有关；而女性T2DM患者合并骨质疏松与年龄（β＝0.287，P＝0.017）、糖化血红蛋白（β＝2.193，P＝0.002）及骨钙素（β＝0.447，P＝0.003）等因素有关。结论糖尿病病程与低尿酸血症可能是男性T2DM患者发生骨质疏松的危险因素；而女性T2DM患者骨质疏松的发生除与年龄及血糖控制情况有关外，还与骨钙素有关。

ObjectiveTo investigate the risk factors for osteoporosis in elderly patients with type 2 diabetes mellitus （T2DM）.MethodsThe levels of bone mineral density （BMD） of lumbar spine, femur neck and hip bone were measured by dual-energy X-ray absorptiometry in 202 T2DM patients aged 60 years and over （102 males and 100 females）. Based on the level of BMD, all patients were divided into 3 groups, including the normal group, the osteopenia group and the osteoporosis group.The markers of glucose, lipid and bone metabolism were examined and compared among groups.ResultsIn males, patients from the osteoporosis group showed shorter duration of T2DM （F=4.184, P=0.018）, lower levels of uric acid （F =4.101, P=0.019） and 25-（OH）D （F =5.712, P=0.004）, and higher levels of HbA1c （F =3.621, P=0.030） among groups.In females, patients in the osteoporosis group had markedly decreased levels of body mass index （F=8.056, P=0.001） and total cholesterol （F=4.787, P=0.011）, increased levels of triglyceride （F=3.502, P=0.034） and osteocalcin （F=3.724, P=0.028）. Additionally, Logistic regression analysis revealed that duration of T2DM （β=-0.059, P=0.044） and uric acid （β=0.006, P=0.012） were the risk factors for osteoporosis in males patients with T2DM.And age （β=0.287, P=0.017）, HbA1c （β=2.193, P=0.002） and osteocalcin （β=0.447, P=0.003） were associated with osteoporosis in T2DM females patients. ConclusionsThe risk factors for osteoporosis in T2DM males are the duration of diabetes and uric acid, while in females are age, HbA1c, and osteocalcin.