女性2型糖尿病患者骨密度测量及骨折风险预测

The Measured of Bone Mineral Density in female patients with type 2 diabetes and its prediction for fracture risk

目的探讨女性2型糖尿病(DM)患者骨密度(BMD)的变化,了解女性2型糖尿病患者骨质疏松性骨折的风险与骨密度的关系。方法应用双能X线骨密度吸收仪测定蚌埠地区169例女性2型DM患者(年龄40～89岁)和151例女性对照人员(年龄40～84岁)L2～4及股骨近端部位BMD,并进行比较。结果①随着年龄增长,女性2型糖尿病患者50～59岁、60～69岁、70～79岁股骨近端部位BMD均低于正常人,L2～4的BMD在60～69岁年龄段低于正常人,差异均有统计学意义;②不论腰椎还是股骨近端部位骨质疏松和骨量减少检出率在女性2型糖尿病患者均明显高于对照组(P<0.01);③女性2型糖尿病合并骨质疏松者中有36例发生41例次骨折,骨折发生例数与BMD的T值降低增加,骨质疏松性骨折患者百分比在Ⅰ区间与Ⅲ区间、Ⅱ区间与Ⅲ区间有显著差异,当BMD≤-3.0SD时骨折发生例数显著增加。结论女性2型糖尿病患者易发生骨密度下降,应引起重视以预防病理性骨折;当BMD≤-3.0SD时骨折发生率明显上升,临床上可将当BMD≤-3.0SD时作为预测骨质疏松性骨折的风险指标。

Objective To study the change of bone mineral density （BMD） in female patients with type 2 diabetes, and to explore the relationship between the risks of the osteoporotic fracture in female patients with type 2 diabetes and the BMD. Methods BMD was measured by dual-energy x-ray absorptiometry at lumbar vertebrae 2-4, the proximal femur （femoral neck, Ward＇s triangle and greater trochanter） in 169 female patients with type 2 diabetes aged 40-89 years and 151 healthy women, and the comparisons were made between the two groups. Results ①Compared to control group, BMD of the proximal femur in female patients with type 2 diabetes at the age of 50-59, 60-69, and 70-79 decreased with statistical significant. BMD of lumbar vertebrae 2-4 in patients aged between 60 and 69 were also significantly lower than those of control group （P〈0.01）.②The incidence of osteoporosis in the female patients with type 2 diabetes at skeletal regions of lumbar spine and left hip are significantly higher than those of control group （P 〈0.01）. ③Compared between female patients with type 2 diabetes and osteoporosis there are 36 eases having 41 incidents of osteoporosis fractures. The number of osteoporosis fracture rose with the lower of BMD T value. There are significant differences in the percentage of patients with Osteoporotie fracture between in -2.0SD ≥ T〉-2.5SD and -2.5SD ≥ T〉-3.0SD and in T ≤-3.0SD. When BMD is ≤-3.0SD the number of osteoporosis fracture occurs increased significantly. Conclusion Female patients with type2 diabetes are prone to bone loss, to which attention should be drawn in case of pathologic fracture; The incidence of fracture increased significantly when T value of is ≤-3.0SD, which suggests that T value of BMD can be used as a risk indicator for osteoporosis fracture.