降糖药物对骨代谢及骨折风险的影响

Effect of hypoglycemic drugs on bone metabolism and fracture risk

2型糖尿病(Type 2 diabetes mellitus,T2DM)是一种发病率很高的慢性病,过去20年进行的一些研究调查了糖尿病(diabetes mellitus,DM)与骨质疏松症及骨代谢之间的关系,脆性骨折(无外伤或较微外伤情况下引起的骨折)增加的风险已经在T2DM患者中表现出来^([1])。在大多数T2DM患者中,抗DM药物对于血糖控制是不可或缺的,然而,它们在骨代谢及对骨折风险有着不同的影响,二甲双胍,磺酰脲类不增加骨折风险,噻唑烷二酮类药物的使用会导致骨质流失加速和骨折风险增加,基于肠降血糖素的治疗方案对骨骼安全性的数据有限,仍需进一步基础及临床研究以明确,钠葡萄糖协同转运蛋白2抑制剂可能通过引发甲状旁腺机能亢进而增加骨折风险,同时,使用胰岛素治疗的患者可能需更多关注DM并发症及低血糖所致的骨折风险增加。本文拟对降糖药物T2DM患者骨代谢及骨折风险的影响作一综述,为T2DM患者药物降糖治疗提供指导。

Type 2 diabetes(T2DM)is a chronic disease with high morbidity.In the past 20 years,some studies have investigated the relationship between diabetes and osteoporosis and bone metabolism.The increased risk of fragility fractures(fractures without trauma or less traumatic conditions)has been demonstrated in patients with T2DM.For most T2DM patients,anti-diabetic drugs are essential for glycemic control.However,the drugs have different effect on bone metabolism and fracture risk.Metformin and sulfonylureas do not increase fracture risk.The use of thiazolidinediones leads to accelerated bone loss and increased risk of bone fractures.There are limited data of incretin-based therapies on the safety of bones.Further basic and clinical studies are needed to make it clear.Sodium glucose cotransporter 2 inhibitors may increase fracture risk by triggering hyperparathyroidism.At the same time,patients treated with insulin may need to pay more attention to DM complications and increased risk of fractures due to hypoglycemia.This article reviews the effect of hypoglycemic drugs on bone metabolism and bone fracture risk in patients with T2DM,and provides guidance for hypoglycemic therapy in patients with T2DM.