2型糖尿病合并骨质疏松患者的骨代谢指标变化分析

Changes of bone metabolism indexes in type 2 diabetes patients with osteoporosis

目的分析2型糖尿病(T2DM)患者骨质疏松发生率及骨代谢指标的变化。方法纳入2016年1月—2019年12月中铁阜阳医院收治的120例T2DM患者(T2DM组)及200例非T2DM患者(非T2DM组),采用双能X线测定骨密度(BMD),检测骨代谢生化标志物(骨钙素、骨硬化素等)。对两组患者腰椎(L1~L4)、股骨颈、桡骨远端BMD及骨代谢生化指标等进行对比分析。结果T2DM组骨质疏松、骨量减少率均高于非T2DM组(P<0.05)。T2DM组患者腰椎和股骨颈BMD均高于非T2DM组(P<0.05)。T2DM组患者血清骨钙素浓度显著高于非T2DM组(P<0.05)。两组血清硬化素浓度比较差异无统计学意义(P>0.05)。T2DM组每天步行时间<2 h患者血清硬化素浓度显著高于每天步行>2 h的T2DM组患者(P<0.05)。T2DM合并骨折患者的骨钙素水平和桡骨远端骨密度均低于T2DM合并骨质疏松无骨折患者和T2DM合并骨量减少无骨折患者(P<0.05)。结论T2DM患者骨质疏松、骨折发生率较高。T2DM骨折患者的骨钙素水平较低,而日常步行活动时间较少的T2DM患者的骨硬化素水平较高,提示T2DM患者骨重塑较低和/或骨质量下降。

Objective To analyze the changes in incidence of osteoporosis and bone metabolism indexes in patients with type 2 diabetes(T2DM).Methods Include 120 T2DM patients(T2DM group)and 200 non-T2DM patients(non-T2DM group)admitted to the hospital from January 2016 to December 2019,and used dual-energy X-ray to determine bone mineral density(BMD)and detected bone metabolism Biochemical markers(osteocalcin,bone sclerostin,etc.).BMD of lumbar spine(L1L4),femoral neck and distal radius and biochemical indexes of bone metabolism were compared and analyzed between the two groups.Results The rates of osteoporosis and bone loss in the T2DM group were higher than that in the non-T2DM group(P<0.05).The BMD of lumbar spine and femoral neck of T2DM patients were higher than that of the non-T2DM group(P<0.05).The concentration of serum osteocalcin in the T2DM group was significantly higher than that in the non-T2DM group(P<0.05).The serum sclerostin concentration between the two groups was not statistically significant(P>0.05).The serum sclerostin concentration of the patients in the T2DM group who walked for less than 2 hrs per day was significantly higher than that of the T2DM group patients who walked for more than 2 hrs per day(P<0.05).The levels of osteocalcin and BDM of distal radius in T2DM patients with fractures were lower than those of T2DM patients with osteoporosis without fractures and T2DM patients with osteopenia without fractures(P<0.05).Conclusion Incidence of osteoporosis/fracture was higher in patients with T2DM.Osteocalcin levels were significantly lower in T2DM patients with fracture,while serum sclerostin were significantly higher in T2DM patients with lower daily walking activity,suggesting lower bone remodeling and/or decreased bone mass in patients with T2DM.