老年2型糖尿病女性骨质疏松状况及其影响因素

Prevalence of osteoporosis and factors affecting bone mineral density in elderly women with type 2 diabetes mellitus

目的探讨老年2型糖尿病（T2DM）女性骨质疏松状况及影响因素。方法2011年1月到2012年2月人组167例老年T2DM女性患者及138名老年健康女性（对照组）。对两组受试者进行健康问卷调查，并检测其骨密度（BMD）和生化、骨代谢指标。应用多因素Logistic回归、多元相关与回归分析该人群骨质疏松情况及其影响因素。结果T2DM组167例，年龄60～78岁；对照组138例，年龄60～80岁。老年T2DM女性骨量减低和骨质疏松者共占85．6％（143／167），显著低于对照组的97．1％f134／138）（X2=11．929，P=0．001）。T2DM组发生低骨量和骨折的风险分别是对照组的0．178倍和1．776倍。以骨量减低为因变量，锻炼频率、锻炼年限和体质指数（BMI）进入多因素Logistic回归方程，回归系数为：-0．438、-0．840、-0．297，均P〈0．05。T2DM未进入该方程但进入了以骨折为因变量的多因素Logistic回归方程。T2DM组酒石酸酸性磷酸酶5b、尿羟脯氨酸／肌酐比值显著高于对照组（校正BMI和生活方式后F=3．818、1．541，均P〈0．05），而骨钙素和骨特异性碱性磷酸酶则显著低于对照组（校正BMI和生活方式后F=0．407、0．920，均P〈0．05）。结论老年T2DM女性发生低骨量的风险低于对照组，但骨折发生率高；其骨代谢特征是骨吸收增加且骨形成减少，症状则更加隐匿。

Objective To investigate the prevalence of osteoporosis in elderly women with type 2 diabetes mellitus（T2DM） and associated factors. Methods From January 2011 to February 2012, 167 elderly women with T2DM and 138 healthy elderly women （controls） were enrolled in this study. The medical history, bone densitometry and biochemical indicators were recorded in the two groups. Data were analyzed with multivariate logistic regression and multiple regression analysis to identify the impacting factors of the osteoporosis in the elderly female patients with T2DM. Results There were 167 elderly women in T2DM group, aged 60-78 years; and 138 elderly women in control group, aged 60-80 years. Total incidence of oste0penia and osteoporosis in T2DM group （85.6%（143/167）） was lower than that in control group（97.1% （134/138））（XZ=11.929, P=0.001）. The risk of developing low bone mass and fracture in T2DM group was 0.178 and 1.776 times of that in control group, respectively. Set low bone mass as dependent variable, the variables of frequency of physical exercise, duration of physical exercise and body mass index（BMI） entered the logistic regression equation, and the regression coefficients B were- 0.438,- 0.840 and- 0.297, respectively, all P〈0.05. T2DM was excluded from this equation, but it entered the logistic regression equation with fracture as dependent variable. The levels of tartrate-resistant acid phosphatase 5b and urinary hydroxyproline/creatinine were higher in T2DM group than those in control group（adjusted for BMI and life style, F=3.818, 1.541, both P〈0.05）. While the levels of bone glaprotein and bone-specific alkaline phosphatase were lower in T2DM group than those in control participants （adjusted for BMI and life style, F= 0.407, 0.920, both P〈0.05）. Conclusion The risk of developing low bone mass is lower in elderly women with T2DM than the control participants, but the risk for fracture is higher, and the osteoporosis in these patients is more difficult to be identified.