抗阻运动在2型糖尿病合并骨质疏松症治疗中的研究进展

Research progress of resistance training in the treatment of type 2 diabetes complicated with osteoporosis

2型糖尿病(type 2 diabetes mellitus,T2DM)和骨质疏松症(osteoporosis,OP)经常共存,导致中老年患者的病死率大幅度提升,两者严重的并发症为社会带来巨大的负担。T2DM患者中存在“糖尿病骨脆性悖论”,出现高骨密度高骨折风险的现象,加之有些降糖药物也能引起骨代谢异常,T2DM患者更易出现骨质疏松。但临床工作中往往忽视了对糖尿病患者骨质的保护,即使明确了OP的诊断,但因抗骨质疏松药物的副作用多、成本高、依从性差等原因,导致长期使用受限。抗阻运动有降糖护骨的作用,可作为一种有早期预防和治疗作用的非药物策略在T2DM患者合并OP患者中推广。我们从T2DM与骨代谢之间的关系及相关发病机制,抗阻运动对血糖、骨骼肌质量的影响,抗阻运动降糖、防治骨质疏松的机制以及抗阻运动方案制定四大方面进行阐述,对抗阻运动在T2DM合并骨质疏松治疗中的研究进展进行综述。

Type 2 diabetes often coexists with osteoporosis,leading to a significant increase in mortality in middle-aged and elderly patients,and both place a huge burden on society.There is a"diabetic bone fragility paradox"in type 2 diabetes,a high bone mineral density and high fracture risk phenomenon.In addition,some hypoglycemic drugs can also cause abnormal bone metabolism,patients with type 2 diabetes are more likely to develop osteoporosis.However,the protection of bone in patients with diabetes is often neglected in clinical practice.Even if the diagnosis of osteoporosis is clear,long-term use of anti-osteoporosis drugs is limited due to many side effects,high cost,poor compliance and other reasons.Resistance exercise(RT)has hypoglycemic and bone protection effects and can be promoted as a non-pharmacological strategy for the early prevention and treatment of type 2 diabetes patients with osteoporosis.We reviewed the research progress of RT in the treatment of T2DM with osteoporosis from four aspects:the relationship between T2DM and bone metabolism and the related pathogenesis,the impact of RT on blood glucose and skeletal muscle quality,the mechanism of RT in reducing glucose,preventing and treating osteoporosis,and the formulation of RT protocol.