FRAX~评估绝经后女性2型糖尿病患者的骨折概率

Assessment of fracture probability in postmenopausal women with type 2 diabetes mellitus by FRAX~

目的：评估绝经后女性2型糖尿病（type 2 diabetes mellitus,T2DM）患者未来10年内发生髋部骨折和主要骨质疏松性骨折的概率。方法：选取298例住院的绝经后T2DM女性患者及183例非糖尿病绝经后女性对照者,采用双能X线骨密度仪测其定腰椎2-4（L2-L4）、股骨颈骨密度。采用FRAX中国模式计算其10年内髋部骨折概率和主要骨质疏松性骨折概率。结果：绝经后T2DM女性患者的10年内髋部骨折概率为（0.94±1.03）%,10年内主要骨质疏松性骨折概率为（3.58±1.68）%。与绝经后女性对照组相比,绝经后T2DM女性患者的股骨颈骨密度[（0.83±0.13）g/cm2比（0.80±0.11）g/cm2,P=0.047]和L2-L4骨密度[（1.04±0.17）g/cm2比（0.97±0.14）g/cm2,P〈0.001]均显著增高,差异有统计学意义（P〈0.05）。但使用FRAX评估的10年内髋部骨折概率[（0.94±1.03）%比（0.96±0.80）%,P=0.814]和主要骨质疏松性骨折概率[（3.58±1.68）%比（3.72±1.35）%,P=0.305],在绝经后T2DM组与对照组间无统计学差异。结论：尽管绝经后T2DM女性患者的股骨颈骨密度和L2-L4骨密度均显著高于对照者,但2组间的10年内发生骨折概率无统计学差异。绝经后女性T2DM患者的骨密度增高及未将T2DM作为一个危险因素纳入FRAX誖计算系统中,可能是2组间骨折概率无差异的原因所在。因此,在未来的FRAX测评系统中,需将T2DM作为一个独立的危险因素纳入其中。

Objective： To evaluate the future lO-year probability of hip fracture （HF） and major osteoporotic fracture （MF） in postmenopausal women with type 2 diabetes mellitus （T2DM）. Methods： A total of 481 postmenopausal women were enrolled, including 298 subjects with T2DM and 183 normal controls. Bone mineral densities （BMD） at lumbar spine （L-24） and femoral neck （FN） were measured by dual energy X-ray absorptiometry （DXA）. A Chinese-specific FRAX model was used in calculating the future 10-year probability of HF and major MF. Results： The future 10-year probability of HF and MF of postmenopausal women with T2DM was （0.94±1.03）% and （3.58±1.68）%, respectively. BMDs at FN [（0.83±0.13） g/cm2 vs （0.80±0.11） g/cm2,p=0.047] and I2-4 [（1.04±0.17） g/cm2 vs （0.97±0.14） g/cm2, P〈 0.001] was significantly higher in the T2DM cohort as compared with the healthy controls （P〈0.05）. There was no significant difference in probability of HF [（0.94±1.03）% vs （0.96±0.80）%, P=0.814] and MF [（3.58±1.68）% vs （3.72± 1.35）%, P=0.305] between the T2DM cohort and healthy controls. Conclusions： Although BMD at the FN and L2-4 are significantly higher in T2DM cohort, the 10-year probability of MF and HF is similar between T2DM cohort and healthy controls. The increased BMD in T2DM and the exclusion of T2DM as a risk factor in the FRAX algorithm may be the possible explanation for the no significant difference in fracture probability between the two groups. Therefore, T2DM should be taken as an independent risk factor into the future FRAX algorithm.