老年2型糖尿病相关风险因素与骨密度及骨折风险的关系研究

Relationship of bone mineral density and fracture risk with type 2 diabetes mellitus-related factors in elderly patients

目的 探讨老年T2DM人群的相关风险因素与骨密度(bone mineral density, BMD)以及骨折风险之间的关系。方法 收集307例老年T2DM病人的相关临床指标和BMD,计算10年主要骨质疏松性骨折发生概率(probability of a major osteoporotic fracture, PMOF)和10年髋部骨折发生概率(probability of a hip fracture, PHF),分析糖尿病相关因素如病程、胰岛素水平、C-肽水平、用药情况与BMD和骨折发生风险之间的关系。结果 T2DM病人的BMD随着病程的延长未有明显变化(P>0.05),但PMOF和PHF明显增高(P_(trend)<0.05)。注射胰岛素组的T2DM病人第1、3、4腰椎以及股骨颈的BMD均高于口服降糖药物组(P<0.05),但2组间PMOF和PHF差异无统计学意义(P>0.05)。胰岛素和C-肽水平按四分位分组后发现,随着血清中胰岛素、C肽水平升高,第1~2腰椎以及股骨颈BMD呈逐渐增高的趋势(P_(trend)<0.05),但PMOF和PHF差异无统计学意义(P>0.05)。线性回归方程发现,第1腰椎的BMD与胰岛素水平、降糖方式呈正相关;与神经病变、低血糖发生率呈负相关(P<0.05)。PMOF和PHF与低血糖发生率、血管病变呈正相关(P<0.05)。结论 T2DM的相关因素与病人的BMD和骨折风险关系复杂,BMD水平与胰岛素的应用相关,而骨折风险却随着糖尿病病程、并发症、低血糖的发生而增加,因此需要筛查出糖尿病病人的骨折高风险人群,予以合适的治疗。

Objective To investigate the relationship of type 2 diabetes mellitus(T2DM)-related factors with bone mineral density(BMD)and fracture risk in the elderly T2DM patients.Methods The clinical data of 307 elderly patients with T2DM were collected.The 10-year probability of a major osteoporotic fracture(PMOF)and the 10-year probability of a hip fracture(PHF)were estimated using Fracture Risk Assessment Tool(FRAX).The relationship of T2DM-related factors such as disease duration,the levels of insulin and C-peptide,medication usage with BMD and the risk of fracture were explored.Results With the increase of T2DM duration,BMD showed no significant change(P>0.05),while PMOF,PHF increased significantly(P trend<0.05).The level of BMD at lumbar spine(L1,L3,L4)and femur neck(FN)in the patients receiving insulin-injection were higher than those in the patients receiving oral hypoglycemic agents.With the increase of the levels of insulin and C-peptide,the levels of BMD at L1-2 and FN showed a gradual increasing trend(P trend<0.05),but there was no statistically significant difference in PMOF and PHF(P>0.05).In the linear regression,BMD at L1 was positively correlated with the level of insulin and insulin injection,and negatively correlated with neuropathy and hypoglycemia(P<0.05);PMOF and PHF had a positive correlation with hypoglycemia and diabetic vascular disease(P<0.05).Conclusions There is complex relationship of BMD and fracture risk with T2DM-related factors.BMD may increase with the usage of insulin,while fracture risk increases with disease duration,complication and hypoglycemia.Therefore,it is necessary to screen the high risk of fracture in the elderly patients with T2DM.