骨折风险预测简易工具对住院2型糖尿病患者骨折风险的预测及临床意义

Prediction and clinical significance of Fracture Risk Assessment Toll to type 2 diabetes mellitus patients in hospital with the risk of osteoporotic fracture

目的探讨骨折风险预测简易工具(FRAX)预测住院低骨量2型糖尿病(T2DM)患者发生骨质疏松性骨折的风险。方法采用随机选择175例住院T2DM患者作为T2DM组,同期门诊非T2DM患者108例作为对照组。受试者均采用双能X线骨密度测量仪(DXA)检测腰椎(L1-4)及左侧股骨(股骨颈、大转子、wards三角)的骨密度(BMD),记录每例患者日常生活中可能影响骨代谢的危险因素,根据体重指数(BMI)和股骨颈BMD,用FRAX计算10年主要骨质疏松性骨折发生概率(临床性脊椎、髋骨、前臂和肱骨骨折)和10年髋部骨折发生概率。结果 T2DM组BMD与对照组相比无明显下降(P>0.05),但发生骨质疏松性骨折的风险却明显增高(P<0.05);根据BMI计算10年全部主要骨质疏松性骨折(BBMO)发生概率和10年髋部骨折(BBHF)发生概率、根据股骨颈骨密度计算10年全部主要骨质疏松性骨折(BMO)发生概率和10年髋部骨折(BHF)发生概率之间呈显著正相关(P<0.001);年龄、绝经年限、BMI、吸烟、补充钙与维生素D、以往骨折史、骨质疏松病史、父母髋部骨折史、糖尿病病史等与发生骨质疏松性骨折的风险密切相关(均P<0.05)。结论 T2DM患者较对照组更易发生骨质疏松性骨折,并与多种危险因素密切相关;常规补充适量钙剂和维生素D、进行体育运动、控制血糖等可预防和减少骨质疏松性骨折。

Objective With Fracture Risk Assessment Tool （ FRAX） , to predict the risk of osteoporotic frac-ture in hospitalized low bone mass patients with type 2 diabetes mellitus （T2DM）.Methods The 175 patients with T2DM in hospital were simple random sample , and the 108 patients with non-T2DM in outpatient service were selected as the control group at the same time.All patients’bone mineral density （BMD） at lumbar （L1-4）, the left femur （inclu-ding femoral neck , greater trochanter and wards triangle ） were tested by dual energy X-ray absorptiometry instrument （ DXA） , and the dangerous factors which may influence bone metabolism in daily life of each patient was recorded , ac-cording to body mass index （ BMI） and the femoral neck ’s BMD and utilize the FRAX to calculate the primary osteoporosis fracture probability （ including clinical spine , hip, forearm and humerus fractures ） and hip fracture probability for 10 years.Results BMD wasn’t lower obviously in T2DM hospitalized patients than that in control group （P〉0.05）, but the risk of osteoporotic fracture was significantly higher （ P〈0.05 ） .It was significantly positive correlation between the BMI and the BMD at neck and 10 years probability of all primary osteoporosis fracture （BBMO）, of hip fracture and of all major osteoporotic fractures （BMO）, of hip fracture （BHF） （P〈0.001）.The risk of osteoporotic fracture was colsely associated to 1 years since post menopause , BMI, smoking, supplementary calcium and vitamin D , previous history of fracture, osteoporosis history, parents hip fracture history, diabetes history and so on （P〈0.05）.Conclusion The pa-tients with T2DM had the higher osteoporotic fracture risk than the control group , and it was closely associated to variety of risk factors;It was beneficial to reduce the occurrence of osteoporotic fractures by supplementing appropriate calcium and vitamin D, doing sports and controlling the blood sugar .