二甲双胍和西格列汀治疗对绝经后糖尿病合并骨质疏松症妇女骨密度和骨代谢的影响

Effects of metformin and sitagliptin on bone mineral density and bone metabolism in postmenopausal women with osteoporosis

目的评估二甲双胍和西格列汀治疗对绝经后糖尿病合并骨质疏松症妇女骨密度和骨代谢的作用。方法将160例绝经后糖尿病合并骨质疏松症妇女随机分为两组。二甲双胍组每天两次接受二甲双胍(Glucophage 500 mg)1片,西格列汀组接受西格列汀(Januvia 100 mg)1片/d,持续24周。收集空腹血液和尿液样品用于血清总碱性磷酸酶(ALP)、骨钙蛋白和尿脱氧吡啶啉(DPD)在基线、8周和16周后以及研究结束时的检测。在基线和干预24周后通过双能X射线吸收测定法检测前后腰椎(L1-L4)的骨密度。结果在二甲双胍组中,治疗24周时所有骨转换标志物的平均值与基线差异无统计学意义。在西格列汀组,平均血清总ALP显著降低,血清骨钙素水平在24周时下降10%,尿DPD下降,在24周时下降维持在28%。结论24周时间内使用二甲双胍不能改善骨密度和骨代谢;而西格列汀可以正向调节骨代谢。

Objective The study evaluated the anti-osteoporotic effect of metformin and sitagliptin in postmenopausal diabetic women.Methods 160 postmenopausal diabetic women were randomly divided into two equal groups.Group metformin received metformin(Glucophage 500 mg)1 tablet twice daily,and group 2 received sitagliptin(Januvia 100 mg)1 tablet/day,for 24 weeks.Fasting blood and urine samples were collected for measurement of serum total alkaline phosphatase(ALP),osteocalcin,and urinary deoxypyridinoline(DPD).Laboratory tests were measured at baseline,after 8 and 16 weeks,and at the end of the study.Bone mineral density of the anterior posterior lumbar spine was measured by dual energy X-ray absorptiometry at baseline and after 24 weeks of the intervention.Results In the metformin-treated group,the mean values for all markers of bone turnover at 24 weeks of treatment were not significantly different from baseline.In sitagliptin group,the mean serum total ALP was significantly decreased,serum osteocalcin levels were non-significantly decreased gradually by 10%at 24 weeks,while urinary DPD decreased significantly and was then maintained at 28%decrease at 24 weeks.Conclusion Metformin is neither osteogenic nor has anti-osteoporotic effect,while sitagliptin can positively regulate bone metabolism.