调整后骨折风险工具预测2型糖尿病患者骨折风险相关临床危险因素研究

Clinical risk factors for fracture risk prediction in patients with type 2 diabetes using adjusted FRAX

目的研究调整后骨折风险工具(fracture risk assessment tool,FRAX)预测2型糖尿病(type 2 diabetes mellitus,T2DM)患者骨质疏松性骨折(osteoporotic fracture,OF)风险和相关临床危险因素关系。方法通过横断面研究方法收集2019年9月至2020年9月于南京医科大学附属淮安第一医院内分泌科及老年医学科住院的T2DM患者429例,根据调整后FRAX预测T2DM患者未来10年OF发生概率,分为OF低危组和OF高危组。收集患者一般临床特征(年龄、性别、身高、体重、血压、血清葡萄糖、糖化血红蛋白、总胆固醇、甘油三酯、低密度脂蛋白胆固醇,高密度脂蛋白胆固醇、血清尿酸、碱性磷酸酶、促甲状腺激素、尿蛋白/肌酐比值、尿素、肌酐和TPOAB)和双能X线骨密度检查结果。比较两组间临床特征,Logistic回归模型用来研究调整后FRAX预测T2DM患者OF风险和临床危险因素之间的关系。结果T2DM患者OF高危组39例,占总人数9.09%,在调整其他变量后,T2DM患者糖尿病病程仍与调整后FRAX预测OF风险增高呈显著性正相关(OR 7.660,95%CI 1.661~35.334,P=0.009),而血尿酸水平与调整后FRAX预测OF风险增高呈显著负相关(OR 0.345,95%CI 0.128~0.928,P=0.035),血LDL-C与调整后FRAX预测OF风险增高也呈显著负相关(OR 0.316,95%CI 0.114~0.881,P=0.028)。在调整了其他变量后,碱性磷酸酶(OR 1.902,95%CI 0.904~4.004,P=0.090)及胆固醇水平(OR 0.297,95%CI 0.056~1.560,P=0.151)与调整后FRAX预测OF风险增高不再具有统计学上的显著性意义。结论糖尿病病程可能是调整后FRAX预测T2DM患者OF风险增加的危险因素,血尿酸和LDL-C可能是调整FRAX预测T2DM患者OF风险增加的保护因素。

Objective To study the clinical risk factors for osteoporotic fracture(OF)risk prediction in patients with type 2 diabetes mellitus(T2DM)using adjusted fracture risk assessment tool(FRAX).Methods A cross-sectional study of 429 patients with T2DM who were hospitalized in the Department of Endocrinology and Geriatrics of the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University from Sep.2019 to Sep.2020 was conducted.Participants were divided into OF low-risk group and OF high-risk group.Participant characteristics(age,gender,height,weight,waist,blood pressure,history of drug treatment,serum glucose,glycosylated hemoglobin,total cholesterol,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triglyceride,serum uric acid,alkaline phosphatase,and thyroid stimulating hormone levels,urine protein/creatinine ratio,urea,creatinine and TPOAB)and dual energy x-ray absorptiometry results were obtained and analyzed.Logistic regression model was used to investigate the relationship between the OF risk of T2DM assessed by adjusted FRAX and clinical risk factors.Results Patients in the OF high-risk group accounted for 9.09%of the subjects.After adjustment for other variables,the duration of diabetes was still positively associated with significantly elevated risk of OF assessed by adjusted FRAX(OR 7.660,95%CI 1.661-35.334,P=0.009),whereas the blood uric acid was negatively associated with significantly elevated risk of OF assessed by adjusted FRAX(OR 0.345,95%CI 0.128-0.928,P=0.035).Likewise,LDL-C levels decreased the odds of the risk of OF assessed by adjusted FRAX(OR 0.316,95%CI 0.114-0.881,P=0.028).There was no significant relationship between alkaline phosphatase(OR 1.902,95%CI 0.904-4.004,P=0.090)as well as total cholesterol(OR 0.297,95%CI 0.056~1.560,P=0.151)levels and the elevated risk of OF assessed by adjusted FRAX.Conclusion Diabetes duration could be a risk factor for OF risk prediction in patients with T2DM using adjusted FRAX,and serum uric acid and LDL-C could be protective factors for OF risk prediction in patients with T2DM using adjusted FRAX.