2型糖尿病与非糖尿病患者FRAX骨折风险的比较

Comparison of FRAX fracture risk in T2DM and non-DM patients

目的验证FRAX骨折风险评估模型对预测2型糖尿病患者骨折风险的有效性。方法收集2009年10月至2013年1月在复旦大学附属中山医院内分泌科住院治疗的40~90岁的2型糖尿病患者752例(T2DM组);选取同期在我院体检中心体检的未确诊糖尿病的体检者595例(对照组);收集相关资料,测定股骨颈、全髋和腰椎骨密度。比较T2DM组与对照组的骨密度,分析2型糖尿病患者发生骨量异常的风险;比较T2DM组与对照组的FRAX骨折风险。结果根据标准共入选682例T2DM患者和417例对照。与对照组相比,T2DM组的骨密度高。与对照组相比,T2DM组发生骨量异常的风险降低,但在校正年龄、性别、饮酒史、吸烟史、BMI和LDL-c后,差异无统计学意义(OR=0.829,P=0.236)。根据FRAX骨折风险模型,T2DM组未来10年发生主要骨质疏松性骨折与髋部骨折风险均有低于对照组的倾向。结论骨密度和FRAX骨折风险评估模型可能会低估2型糖尿病患者未来10年发生主要骨质疏松性骨折和髋部骨折风险,该模型在糖尿病患者中的应用还需进一步校正。

Objective To evaluate the value of WHO fracture risk assessment tool（ FRAX） to predict fracture risk in T2 DM patients. Methods A total of 752 T2 DM patients（ 40- 49 years old） admitted in Endocrinology Department of Zhongshan Hospital,Fudan University from Oct.,2009 to Jan.,2013 were collected as T2 DM group,and 595 cases without T2 DM from physical examination center of Zhongshan Hospital,Fudan University were collected as control group. Bone mineral density（ BMD） of femoral neck,total hip and lumbar was measured and compared between T2 DM group and control group,and the risk of abnormal bone mass was analyzed between the two groups. Furthermore,we compared the FRAX fracture risk between T2 DM group and control group. Results Ultimately682 T2 DM patients and 417 controls were enrolled according to the standards. BMD in T2 DM group was higher than control group. The risk of abnormal bone mass for T2 DM group was lower than control group.However,after adjusting for age,gender,drinking,smoking,BMI and LDL-c,there was no statistically significant difference（ OR = 0. 829,P = 0. 236）. Compared with control group,the 10-year probability of a major osteoporotic fracture and hip fracture in T2 DM group were lower according to the FRAX model.Conclusions BMD and FRAX may underestimate the 10-year probability of the major osteoporotic fracture risk and hip fracture risk for T2 DM patients. This model may need further correction for T2 DM patients.