抗骨质疏松症药物对糖尿病患者糖代谢及骨代谢的影响

Effects of anti-osteoporotic drugs on glucose and bone metabolism in diabetic patients

糖尿病是骨质疏松性骨折的危险因素之一,无论是1型还是2型糖尿病患者,其发生骨质疏松症和糖尿病性骨折的风险均显著升高。研究表明,糖尿病患者骨转换指标明显低于正常人群,尤其是骨形成动力不足。目前针对糖尿病合并骨质疏松症患者的抗骨质疏松治疗尚无明确的指南。抗骨质疏松症药物尤其是抗骨吸收药物,可进一步降低骨转换,同时,其可能影响骨钙素(osteocalcin,OC)等细胞因子的分泌从而对糖代谢产生不利影响。而目前许多动物实验及临床研究发现,常用抗骨质疏松症药物用于糖尿病患者不仅有抗骨质疏松作用,甚至可能对糖代谢产生积极影响。本文通过综述抗骨质疏松症药物对糖尿病患者糖代谢及骨代谢的影响,旨在为糖尿病患者抗骨质疏松治疗及避免糖尿病性骨折的发生提供有效的参考。

Diabetes is one of the risk factors of osteoporotic fractures,and there is a significant increase in the risk of osteoporotic and diabetic fractures in patients with type 1 and type 2 diabetes.Studies have shown that the bone turnover in diabetic patients is significantly lower than that in the normal population,especially in terms of bone formation dynamics.There is no clear guidance for the treatment of osteoporosis in patients with diabetes and osteoporosis.Anti-osteoporotic drugs,particularly anti-resorptive drugs can further reduce bone turnover,and affect the secretion of cytokines such as osteocalcin,which may adversely affect glucose metabolism.Currently,many animal experiments and clinical studies have found that commonly used anti-osteoporotic drugs in diabetic patients not only have anti-osteoporosis effects but also have a positive effect on glucose metabolism.This article reviews the effects of anti-osteoporotic drugs on glucose metabolism and bone metabolism in diabetic patients,and hopes to provide an effective reference for the anti-osteoporotic treatment in diabetic patients and to avoid the occurrence of diabetic fractures.