T2DM对老年绝经后骨密度、骨转换及骨质疏松性骨折风险的影响研究

Study on the effect of T2DM on bone mineral density,bone turnover and risk of osteoporotic fracture in elderly postmenopausal women

目的:探讨II型糖尿病(type II diabetes mellitus,T2DM)对老年绝经后骨密度、骨转换及骨质疏松性骨折(osteoporotic fracture,OPF)风险的影响。方法:75例老年绝经后T2DM患者和40例同年龄段的健康绝经后女性,分别记为T2DM组和健康组。采用双能X线骨密度仪(dual energy X-ray absorptiometry,DXA)测量骨密度(bone mass density,BMD)指标(股骨颈、全髋及腰椎BMD),DXA自带分析软件计算股骨强度指数(femur strength index,FSI)、截面指数(section modulus,SM)、横截面面积(cross-sectional area,CSA)及曲线比率(buckling ratio,BR),同时检测骨转换指标[I型前胶原氨基端肽(total procollagen Type 1 aminoterminal propeptide,P1NP)、β胶联降解产物(β-CrossLaps,β-CTX)],结合3年随访观察两组OPF发生情况。结果:DXA测量显示:T2DM组股骨颈(L1～L4)BMD、全髋BMD、腰椎BMD和股骨近端FSI、SM、CSA明显低于健康组,BR显著高于健康组,差异均有统计学意义(t依次=2.332、2.367、2.314、5.612、5.007、9.835、2.821,P<0.05或<0.01);骨转换检测显示:两组β-CTX水平相较,差异无统计学意义(P>0.05),T2DM组P1NP水平较健康组低[(43.76±18.29)ng/mL vs.(53.84±20.16)ng/mL],差异有统计学意义(t=2.716,P<0.01)。3年随访显示:T2DM组OPF发生率为16.42%,高于健康组的2.78%,差异有统计学意义(χ~2=4.233,P<0.05),T2DM组骨折发生于髋部、脊椎处和桡尺骨远端处。结论:T2DM可能通过降低老年绝经后女性BMD和骨强度及抑制骨生成转换等途径,增加OPF发生风险,应积极采取相关措施预防OPF发生。

Objective:To investigate the effects of type Ⅱ diabetes mellitus (T2DM) on bone mineral density,bone turnover and the risk of osteoporotic fracture (OPF) in elderly postmenopausal women. Methods :A total of 75 elderly postmenopausal patients with T2DM and 40 healthy postmenopausal women of the same age were divided into two groups:T2DM group and healthy group.Bone mass density (BMD) was measured by dual Energy X-ray absorptiometry (DXA).Femur strength index (FSI),section modulus (SM),cross-sectional area (CSA) and buckling ratio (BR) were calculated by DXA software.The bone turnover index [(Total Procollagen Type 1 Aminoterminal Propeptide,P1NP) and beta-crosslinked degradation product (beta-CrossLaps,beta-CTX)] were also measured.The occurrence of OPF in the two groups was observed with 3-year follow-up. Results:DXA measurements showed that BMD,total hip BMD,lumbar BMD and FSI,SM and CSA of proximal femur in T2DM group were significantly lower than those in healthy group,while BR was significantly higher than those in healthy group ( t =2.332,2.367,2.314,5.612,5.007,9.835,2.821, P <0.05 or P <0.01),and bone turnover test showed that there was no significant difference in the level of beta-CTX between the two groups ( P >0.05).The level of P1NP in the T2DM groupwas lower than that in the healthy group[(43.76±18.29)ng/mL vs.(53.84±20.16)ng/mL], and the difference was statistically significant ( t=2.716,P <0.01).3-year follow-up showed that the incidence of OPF in the T2DM group was 16.42%,which was significantly higher than that in the healthy group 2.78%,the difference was statistically significant (χ^2=4.233,P <0.05).Fractures in the T2DM group occurred at the hip,vertebra and distal radius and ulna. Conclusion: T2DM may increase the risk of OPF by reducing BMD and bone strength and inhibiting bone formation and turnover in elderly postmenopausal women,and relevant measures should be taken to prevent the occurrence of OPF.