跟骨定量超声对绝经后女性2型糖尿病患者骨折风险评估的意义

Evaluation of fracture risk in postmenopausal women with type 2 diabetes mellitus based on calcaneus quantitative ultrasound

目的探讨定量超声对绝经后女性T2DM患者骨折风险的评估价值。方法选取2012～2017年于我院内分泌科就诊的绝经后女性T2DM患者492例(T2DM组),同期于我院健康体检的绝经后女性398名(NC组)。运用超声骨密度仪(QUS)和双能X射线骨密度仪(DXA)分别测量两组骨强度指数(SI)、骨密度(BMD)及骨代谢标志物。采用骨折风险预测工具(FRAX)计算10年任何重要部位骨质疏松性骨折概率(PMOF)、髋部骨折概率(PHF),比较两组SI、BMD、PMOF、PHF及骨代谢标志物。采用多元回归分析PMOF、PHF的影响因素。结果 (1)两组BMD和骨质疏松症(OP)患病率比较,差异无统计学意义(P>0.05)。(2)与NC组相比,T2DM组SI、25羟维生素D[25(OH)D]、骨钙素(BGP)、血清I型原胶原N-端前肽(PINP)、血清1型胶原交联β-C-末端肽(β-CTX)降低(P<0.05或P<0.01),HbA1c、PMOF、PHF和甲状旁腺素(PTH)升高(P<0.05或P<0.01);(3)NC组DXA和QUS两种方法T-值(≤-2.5)发生率比较,差异无统计学意义(P>0.05);T2DM组QUS法T-值(≤-2.5)发生率低于DXA法(P<0.05);(4)T2DM组QUS法较DXA法针对FRAX评分的敏感性和特异性均更强(37%vs25%,98%vs 90%);(5)多元回归分析结果显示,SI及PINP、β-CTX是PMOF的影响因素,SI和β-CTX是PHF的影响因素。结论跟骨定量超声和骨代谢标志物可能是评估绝经后女性T2DM患者骨折风险有效手段。

Objective To evaluate the fracture risk in postmenopausal women with type 2diabetes mellitus (T2DM)based on calcaneus quantitative ultrasound (QUS). Methods Postmenopausal women with T2DM from Department of Endocrinology,The Anhui Provincial Hospital Affiliated to Anhui Medical University from 2012to 2017were enrolled in this study and assigned into T2DM group (n =492). And healthy postmenopausal women from physical examination center were assigned into NC group (n =398).Bone strength index (SI)and bone mineral density (BMD)were measured by QUS and dual energy X ray absorptiometry (DXA)respectively in the two groups.Bone turnover markers were tested. Fracture Risk Assessment Tool (FRAX)was used to predict the risk of major osteoporotic fracture (PMOF)and the probability of hip fracture (PHF).SI,BMD,PMOF,PHF and bone turnover markers were compared between the two groups. Results (1)There was no statistically significant difference in BMD and osteoporosis prevalence between T2DM group and NC group (all P >0.05). (2)The SI was lower (P<0.05), PMOF and PHF were higher (P<0.05orP<0.01)in T2DM group than in NC group.The 25-OH-vitamin D [ 25 (OH)D ], osteocalcin (BGP), procollagen type 1aminoterminal propeptide (PINP), and cross-linked C-terminal telopeptide of type I collagen (β-CTX)were decreased,while PTH was increased in T2DM group than in NC group (P<0.05orP<0.01). (3)There was no statistically significant difference in measuring of bone mass between DXA and QUS in NC group (P >0.05). Whereas,the odds of QUS stiffness T score (≤-2.5)was lower than that of BMD (FN)measured by DXA in T2DM group (P<0.05). (4)The sensitivity and specificity regarding to FRAX scores were higher in QUS than in DXA in T2DM group (37% vs 25%,98% vs 90%). (5)In T2DM group,multivariate regression analysis revealed that SI,β-CTX and PINP were negatively correlated with PMOF (β =-0.251,-0.132,-0.235,P<0.05orP<0.01); and SI,β-CTX was negatively correlated with PHF (β =-0.163,-0.132,P<0.05). Conclusion Calcaneus QUS and bone turnover markers may be used as predictors of osteoporotic fracture risk in postmenopausal women with T2DM.