老年男性2型糖尿病患者体重及体重指数与各骨骼部位骨密度及骨质疏松症患病风险的关系

The influence of body weight and body mass index on bone mineral density and osteoporotic risk in elderly men with T2DM

目的分析老年男性2型糖尿病(T2DM)患者的体重及体重指数(BMI)与各骨骼部位骨密度(BMD)及骨质疏松症(OP)患病风险的关系。方法选取长沙市第一医院内分泌代谢科2017年6月至2018年5月收治的210例老年男性T2DM患者为研究对象。测量身高、体重,计算BMI。采用双能X线吸收法测量患者腰椎(LS)、左侧髋部[包括股骨颈(FN)、大转子(G.T.)、转子间(InTro)、总体髋部(TH)]的BMD。根据BMI将患者分为三组:超重组(24.0 kg/m2≤BMI<28.0 kg/m2)、肥胖组(BMI≥28.0 kg/m2)、体重正常组(18.5 kg/m2≤BMI<24.0 kg/m2)。分析体重及BMI与各骨骼部位的BMD及OP患病风险的关系。结果超重组和肥胖组的髋部各骨骼部位BMD均较体重正常组显著增加(P<0.05)。体重及BMI分别与髋部各部位BMD呈正相关(r=0.239~0.427,P<0.05)。按体重和BMI的三分位数分组(T1~T3),髋部各骨骼部位BMD均随体重三分位组增加而增加(P<0.05);TH-BMD亦随BMI三分位组增加而增加(P<0.05)。进一步分别以三分位组的最高组(T3)和较高组(T2)为对照组,最低组(T1)为病例组计算LS、FN、TH三部位的OP患病风险比值比(OR)。以体重三分位分组的股骨颈OP患病风险分别增加4.50倍(OR=4.50,95%CI:1.41~14.35)和9.27倍(OR=9.27,95%CI:2.03~42.30);整体髋部OP患病风险分别增加3.25倍(OR=3.25,95%CI:1.10~9.59)和8.50倍(OR=8.50,95%CI:1.85~38.99)。以BMI三分位分组的股骨颈OP患病风险分别增加4.13倍(OR=4.13,95%CI:1.28~13.25)和5.58倍(OR=5.58,95%CI:1.53~20.42);而整体髋部患病风险差异无统计学意义(P>0.05)。无论是体重还是BMI三分位分组,各组间腰椎BMD及OP患病风险均差异无统计学意义(P>0.05)。结论对于老年男性T2DM患者,体重及BMI是影响髋部BMD的重要因素,亦是影响髋部尤其是股骨颈OP患病风险的重要因素,在一定范围内体重及BMI增加,股骨颈OP患病风险减少。

Objective To investigate the association of body weight and body mass index(BMI)with bone mineral density(BMD)and osteoporotic risk in elderly men with type 2 diabetes mellitus(T2DM).Methods 210 elderly male patients with T2DM admitted to the Department of Endocrinology of the First Hospital of Changsha from June 2017 to May 2018 were selected as the research objects.The height,weight and bone mass index(BMI)were measured.BMDs of the left hip[including femoral neck(FN),greater trochanter(G.T.),intertrochanter(InTro),and total hip(TH)]and lumbar spine(LS)were measured in 210 elderly male patients with T2DM by dual-energy X-ray absorption method.Patients were divided into three groups according to BMI:the overweight group(24.0 kg/m2≤BMI<28.0 kg/m2),the obesity(BMI≥28.0 kg/m2)group,and the normal group(18.5 kg/m2≤BMI<24.0 kg/m2).The influence of body weight and BMI on BMD and osteoporotic risk in these elderly men with T2DM was analyzed.Results The BMDs in various sites of the hip of the overweight group and obesity group were higher compared with those in the normal weight group(P<0.05).There was a positive correlation between weight and BMI with BMDs in various sites of the hip femoral neck(including FN,G.T.,InTro,and TH)(r=0.239-0.427,P<0.05).All patients were divided into different tertiles(T1-T3)stratified by weight and BMI respectively.The BMDs in various sites of the hip increased with tertiles stratified by weight(P<0.05).The TH-BMD also increased with tertiles stratified by BMI(P<0.05).The odd ratios(OR)were calculated using T3 as the control group and T1 as the case group,using T2 as the control group and T1 as the case group,respectively.The osteoporotic risks of T1/T3,T1/T2 at FN stratified by weight were significantly increased by 4.50 times(OR=4.50,95%CI:1.41-14.35)and 9.27 times(OR=9.27,95%CI:2.03-42.30);The osteoporotic risks of T1/T3,T1/T2 at TH were significantly increased by 3.25 times(OR=3.25,95%CI:1.10-9.59)and 8.50 times(OR=8.50,95%CI:1.85-38.99).The osteoporotic risks of T1/T3,T1/T2 at FN stratified by BMI respectively were significantly increased by 4.13 times(OR=4.13,95%CI:1.28-13.25)and 5.58 times(OR=5.58,95%CI:1.53-20.42);while the osteoporotic risks of T1/T3,T1/T2 at TH stratified by BMI were not significantly increased(P>0.05).There was no statistically significant difference in BMDs and the osteoporotic risks of the LS among T1,T2,and T3,regardless of stratified by weight or BMI(P>0.05).Conclusions For elderly males with T2DM,weight and BMI are important factors affecting BMDs in the hip,and also affecting the osteoporotic risks of the hip,especially that of FN.Osteoporotic risks of the FN decrease with the increase of weight and BMI within a certain range.