FRAX、OSTA与骨代谢指标在评价绝经后2型糖尿病患者骨密度中的临床价值

Clinical study of FRAX,OSTA and bone metabolism indexes in evaluating bone mineral density in postmenopausal patients with Type 2 diabetes

目的探讨骨折风险评估工具(FRAX)、亚洲人骨质疏松自我筛查工具(OSTA)与骨代谢指标包括血清骨钙素、25羟维生素D、β-胶原特殊序列及总I型胶原氨基端延长肽对绝经后2型糖尿病性骨质疏松症诊断的评估价值。方法回顾性分析2020年6月至2021年12月期间在南通大学附属医院内分泌科住院治疗的绝经后2型糖尿病患者231例,根据骨密度结果将患者分成骨量正常组、骨量减少组和骨质疏松组,基于基线数据,分别评估FRAX、OSTA与骨代谢指标对绝经后2型糖尿病患者骨质疏松风险的准确性。结果骨质疏松组代入骨密度的FRAX评分较骨量正常组及骨量减少组明显升高,25羟维生素D水平较骨量正常组明显减少,β-CTX、P1NP水平较骨量正常组明显升高(P<0.05);Pearson相关分析提示骨密度与25羟维生素D、β-CTX及P1NP有显著相关性(r值分别为0.30、-0.45、-0.31,P<0.05);受试者工作曲线分析显示:代入骨密度的FRAX(包括未来10年内主要部位及髋部骨折概率)评分、25羟维生素D及β-CTX对区分骨量是否正常具有诊断价值(ROC曲线下面积分别是0.6935、0.8462、0.7118、0.7484)。而OSTA评分在各组间无明显统计学差异。结论结合FRAX、骨代谢指标能够辅助诊断绝经后2型糖尿病合并骨质疏松,具有早期诊断的潜在临床价值。

Objective To explore the relationship between fracture risk assessment tool(FRAX),Asian osteoporosis self-screening tool(OSTA)and bone metabolism indexes including serum osteocalcin,25-hydroxyvitamin D,β-crosslaps and procollagen type 1 N-terminal propeptide in the diagnosis of postmenopausal type 2 diabetes induced osteoporosis.Methods 231 postmenopausal patients with Type 2 diabetes who were hospitalized in the Department of Endocrinology,the Affiliated Hospital of Nantong University from June 2020 to December 2021 were retrospectively analyzed.According to the results of bone mineral density,the patients were divided into normal bone mass group,osteopenia group and osteoporosis group.Based on the baseline data,the accuracy of FRAX,OSTA and bone metabolism indexes on the risk of osteoporosis in postmenopausal patients with Type 2 diabetes were evaluated respectively.Results The FRAX score with bone mineral density in osteoporosis group was significantly higher than that in normal bone mass group and osteopenia group,and 25-hydroxyvitamin D level was significantly lower than that in normal bone mass group,the levels ofβ-CTX and P1NP were significantly higher than those in normal bone mass group(P<0.05);Pearson correlation analysis showed that bone mineral density has significant correlation with 25 hydroxyvitamin D,β-CTX and PINP(r=0.30,-0.45,-0.31,P<0.05);Receiver operator characteristic curve(ROC)analysis showed that:FRAX score with bone mineral density(Including the probability of major parts and hip fractures in the next 10 years),25 hydroxyvitamin D,andβ-CTX has diagnostic value in differentiating whether bone mass is normal or not(AUC=0.6935,0.8462,0.7118,0.7484).And there was no significant difference in OSTA score between the groups.Conclusion FRAX and bone metabolism can assist in the diagnosis of postmenopausal Type 2 diabetes complicated with osteoporosis,which has potential clinical value for early diagnosis.