绝经后女性不同空腹血糖水平和体质量指数与骨密度 的相关性研究

目的探讨绝经后女性不同空腹血糖水平和体质量指数(bone mass index, BMI)与骨密度的相关性。方法纳入202名绝经后妇女作为受试者,其中42例为2型糖尿病(type 2 diabetes mellitus,T2DM)患者(即T2DM组),160名为非2型糖尿病患者(即健康对照组)。通过双能X射线吸收测定法(DXA)获得其腰椎和股骨颈的骨密度(bone mineral density, BMD)数据,并记录其他相关的临床和实验室数据,分析相关变量之间的相关性。结果 T2DM组的BMD显著高于对照组(P0.05);通过空腹血糖和HbA1c水平比较受试者骨质疏松症的患病率时,发现骨质疏松症的患病率随血糖和HbA1c升高而显著降低;此外,T2DM组腰椎和股骨颈的BMD明显高于对照组(P0.05);同时发现骨质疏松症与糖尿病、BMI和饮酒呈负相关,但与年龄、既往骨折史以及肌肉骨骼系统和结缔组织的其他疾病呈正相关;在调整上述因素后,糖尿病与骨质疏松症之间的关联仍然具有统计学意义(P0.05);T2DM与骨质疏松症发病率相关且与BMI不相关(P0.05)。结论与健康对照组相比,T2DM患者腰椎和股骨颈的BMD均较高且不受BMI影响。此外,骨质疏松症的患病率随血糖和HbA1c升高而显著降低。     

血脂测定在绝经后2型糖尿病妇女骨质疏松中的临床意义

目的探讨血脂检测在绝经后2型糖尿病(type 2 diabetes mellitus,T2DM)妇女骨质疏松(osteoporosis,OP)中的临床意义。方法选取2012年1月至2016年6月我院内分泌科收治的绝经后T2DM患者210例,并选取同期体检的60名无糖代谢异常的绝经后女性作为对照组。检测所有研究对象的血糖、血脂及相关生化指标,采用双能X线骨密度仪检测其腰椎1~4及左股骨颈的骨密度(bone mineral density,BMD)。结果 (1)T2DM组的糖尿病病程、空腹血糖(fasting blood glucose,FBG)、餐后2 h血糖、糖化血红蛋白(glycosylated hemoglobin,Hb A1c)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)高于对照组,而高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)及左股骨颈BMD低于对照组(P0.05)。T2DM组中骨量减少及OP组血清磷与BMD正常组相比显著降低,而LDL-C显著增高;OP组与骨量减少组相比LDL-C亦增高(P0.05)。(2)T2DM组Pearson相关分析显示,FBG、血清磷、血尿酸均与腰椎1~4BMD、左股骨颈BMD呈正相关,而碱性磷酸酶、LDL-C均与腰椎1~4 BMD、左股骨颈BMD呈负相关;TC与腰椎1~4 BMD呈负相关,Hb A1c、甘油三酯与左股骨颈BMD呈正相关。(3)多因素Logistic分析显示,LDL-C是绝经后T2DM女性BMD降低的独立危险因素(β=1.522,P=0.000)。(4)ROC曲线结果显示,LDL-C为2.09 mmol/L时预测绝经后T2DM女性BMD降低的敏感性为87.9%、特异性为64.3%,曲线下面积为0.69。结论血清LDL-C水平与绝经后T2DM女性BMD降低密切相关,对临床上早期发现OP并采取有效措施具有指导意义。     

2型糖尿病患者血清Metrnl水平与骨密度的相关性研究

目的 探讨2型糖尿病(diabetes mellitus type 2,T2DM)患者血清Metrnl浓度与骨密度的相关性及其影响因素。方法 选取江苏大学附属医院就诊的T2DM患者146例,对所有受试者进行糖耐量、胰岛素兴奋实验、血生化检测等。ELISA检测血清Metrnl水平。所有受试者均接受双能X线骨密度仪检测,根据骨密度结果分为T2DM合并骨密度(bone mineral density, BMD)正常组和BMD异常组。结果 与T2DM合并BMD正常组相比,T2DM合并BMD异常组血清Metrnl水平显著升高(P<0.05)。进一步在调整性别、年龄等因素后,T2DM患者血清Metrnl水平与第1腰椎(L1)、L2、L3、L2～L4、L1～L4等BMD值,以及L1～L4 T值呈显著负相关(P<0.05)。Logistic回归结果显示,T2DM患者血清Metrnl水平与骨量异常独立相关。ROC曲线模型分析结果显示,血清Metrnl预测T2DM患者骨量异常的曲线下面积为0.720(95%CI=0.638～0.802,P<0.001)。结论T2DM合并BMD异常患者血清...     

绝经后2型糖尿病患者Irisin水平分析

目的通过检测绝经后初诊2型糖尿病(type 2 diabetes mellitus,T2DM)不同骨量人群血清中鸢尾素(Irisin)、25羟维生素D[25-hydroxyvitamin D,25(OH) D]水平,初步探讨其在绝经后初诊糖尿病患者骨量流失过程中的作用及意义。方法选取在遵义医科大学院附属医院内分泌科住院的绝经T2DM女性病人150例,根据骨密度(bone mineral density,BMD)分为T2DM骨量正常组(A组,50例)、T2DM骨量减少组(B组,50例)、T2DM骨质疏松组(C组,50例),收集同期医院体检中心相匹配的绝经后健康女性体检者为正常对照组(NC组,50例)。采用酶联免疫吸附法(enzyme linked immunosorbent assay,Elisa)测定所有受试者血清Irisin水平。运用Pearson相关分析绝经后T2DM合并骨质疏松(osteoporosis,OP)患者血清Irisin与25(OH) D的相关性;通过Logistic回归分析绝经后T2DM病人骨密度的影响因素。结果 A组与B组相比,BMD(Neck,L1～4)、Irisin升高,LDL-C、FINS、Hb A1c、FPG、HOMA-IR明显降低,差异均具有统计学意义(P0. 05); Pearson相关分析显示,Irisin与Hb A1c、FPG、FINS、HOMA-IR、LDL-C均呈负相关,与BMD(Neck、L1～4)、25(OH) D呈正相关。结论血清中Irisin、25(OH) D水平随着骨量流失而逐渐减低,推测其可能共同参与了绝经后女性发生糖代谢紊乱及骨量流失的过程。     

血清OPG、TGF-β和IL-6水平对绝经后骨量减少合并2型糖尿病患者骨折风险的预测

目的研究绝经后骨量减少合并2型糖尿病（T2DM）患者血清骨保护素（OPG）、转化生长因子-β（TGF-β）和白细胞介素-6（IL-6）水平的变化;评估血清OPG、TGF-β和IL-6水平对绝经后骨量减少合并T2DM患者10年骨折风险的影响;分析上述因子在绝经后T2DM患者骨折进展中的作用。 方法该回顾性研究共纳入128名绝经后骨量减少患者,其中64名合并T2DM患者（-2.50.05）;绝经后骨量减少合并T2DM患者血清OPG（Z=2.264,P=0.024）、TGF-β（Z=2.836,P=0.005）和IL-6（Z=2.431,P=0.015）水平高于单纯骨量减少患者;两组患者的血清OPG、TGF-β、IL-6水平与10年骨折风险均存在相关性。 结论绝经后骨量减少合并T2DM患者的促炎细胞因子和OPG水平高于单纯骨量减少患者,促炎因子TGF-β和IL-6水平的升高对于预测绝经后骨量减少合并T2DM患者的骨折风险具有重要意义。     

2型糖尿病对老年绝经后女性骨质疏松性骨折风险的影响

目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)对老年绝经后女性骨质疏松性骨折风险的影响,为预防骨质疏松性骨折及制订相关干预措施提供依据。方法 180例绝经后T2DM女性作为糖尿病组,180例健康绝经后女性作为对照组,比较两组的基本资料、T2DM史、骨折史,骨密度(BMD)、骨转化指标,并比较组间资料和指标差异,生存分析T2DM对骨质疏松性骨折风险的影响。结果糖尿病组腰椎BMD、股骨颈BMD、I型前胶原氨基端肽(procollagen 1 N-terminal peptide,P1NP)显著低于对照组(P0.05),β-Ι型胶原羧基端肽(beta C-terminal telopeptide,β-CTX)组间无显著差异(P0.05);糖尿病组有骨折史人数(率)为25(13.9%),高于对照组12(7.8%)(P0.05),骨折部位分布组间无显著差异(P0.05);生存分析显示T2DM无骨折生存率低于对照组(P0.05)。结论 T2DM可降低老年绝经后女性的骨密度,影响骨转化,可能增加骨质疏松性骨折的风险,应采取措施积极加强预防和干预。     

青中年1型糖尿病及合并微血管并发症者骨密度变化

目的探究青中年1型糖尿病及其微血管并发症患者的骨密度的变化。方法回顾性选取2010年至2019年12月在我科住院的18～50岁的1型糖尿病(type 1 diabetes mellitus,T1DM)患者共129人,并选取同期在我院体检的129名非糖尿病对照,其中所有女性受试者均未绝经。测定所有受试者一般生化指标、25羟维生素D、血清钙、磷、糖化血红蛋白(Hb A1c);测定腰椎、股骨颈及髋部骨密度值;筛查1型糖尿病患者的微血管并发症情况;运用t检验、卡方检验、协变量分析、单因素方差分析、多元线性回归的统计方法研究青中年T1DM及其合并微血管并发症的患者的骨密度变化。结果在男性组中,T1DM患者所有测量部位的BMD均低于非糖尿病对照(P=0.000、0.000、0.018),进一步调整相关临床变量后,各部位骨密度值仍低于对照(P=0.018、0.036、0.018)。多元线性回归发现,病程、血清25羟维生素D浓度、有无微血管并发症可能是影响男性BMD的因素,且合并两种及以上微血管并发症的患者骨密度显著低于1种或无并发症的患者。女性患者的BMD在各种调整模型中均未发现较对照组有统计学差异。结论青中年男性T1DM容易发生骨量流失,尤其是那些合并微血管并发症的患者,因此在青中年男性患者中筛查BMD是十分重要的。     

中老年2型糖尿病患者骨密度与尿酸、胰岛素抵抗关系的研究

目的探讨中老年2型糖尿病患者骨密度与尿酸、胰岛素抵抗的关系。方法根据制定的纳入标准和排除标准,入选了152例中老年2型糖尿病患者,男性组(n=68)和绝经后女性组(n=84),两组年龄、体重指数、糖尿病病程具有均衡性,比较两组代谢组分、各部位骨密度(BMD)及骨代谢指标;pearson相关分析及多元逐步回归分析探讨各部位BMD及骨代谢指标与尿酸、胰岛素抵抗指数(HOMA-IR)的关系。结果两组尿酸、股骨颈、大粗隆、粗隆间、Wards区、腰椎(L1-4)各部位BMD及骨代谢指标有显著性差异。中老年2型糖尿病患者各关节BMD均与尿酸、HOMA-IR呈正相关;男性组各部位BMD与尿酸呈正相关;绝经后女性组各部位BMD与尿酸、HOMA-IR呈正相关。回归分析示尿酸是影响男性L3部位骨密度和β-CTX的独立因素;HOMA-IR是影响女性髋关节和腰椎骨密度的独立因素。结论尿酸可能增加中老年男性2型糖尿病患者的骨密度值,胰岛素抵抗对中老年女性患者维持骨量及促进骨合成可能具有正向调节作用。     

中老年2型糖尿病患者骨代谢特点及骨量丢失危险因素分析

目的探讨中老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者骨代谢特点及骨量丢失危险因素。方法选择中老年T2DM患者612例(男296例,女316例),根据骨密度(bone mineral density,BMD)水平分为骨量正常组(108例)、骨量减少组(281例)、骨质疏松组(223例),分析各组差异及其相关性。结果女性患者中,骨质疏松组的年龄、甲状旁腺激素(parathyroid hormone,PTH)、I型前胶原N-末端肽(procollagen type I N propeptide,PINP)、I型胶原交联C-末端肽(collagen type I cross-linked C-telopeptide,CTX)显著增高,体质量指数(body mass index,BMI)、尿酸(uric acid,UA)、25-羟基维生素D[25-hydroxy vitamin D,25(OH)D]显著降低;腰椎L1~4 BMD与BMI、UA、25(OH)D正相关,与年龄、PTH、PINP、CTX负相关。男性患者中,骨质疏松组PTH显著增高,BMI显著降低;腰椎L1~4 BMD与BMI、UA正相关,与PTH负相关。Logistic回归分析显示高龄、高PTH、高PINP、低BMI、低UA、低25(OH)D是女性T2DM患者骨量丢失的危险因素,高PTH、低BMI是男性骨量丢失的危险因素。结论中老年女性T2DM合并骨质疏松患者骨转换水平增高,而男性骨转换水平无显著变化,但两者骨质疏松的发病可能均与低BMI、高PTH水平有关。     

绝经前女性系统性红斑狼疮患者骨密度和骨代谢指标测定

目的 探讨绝经前女性系统性红斑狼疮(SLE)患者骨密度(BMD)和骨代谢指标的变化.方法 采用双能x线骨密度吸收仪(DEXA)测定178例绝经前女性SLE患者以及60例正常对照组的腰椎、股骨颈的骨密度以及T值,血钙、磷浓度,血清碱性磷酸酶(AKP)、血清骨钙素(BGP)、尿I型胶原交联氨基末端肽(NTX)水平,并将SLE组患者分为SLE初诊组与治疗组,分别对其数据进行统计分析.结果 SLE初诊组的腰椎BMD,股骨颈BMD及T值,血清AKP、尿NTX较正常对照组均无明显差异,而腰椎骨密度T值、血清BGP较正常对照组低(P＜O.05);SLE治疗组的腰椎BMD、T值和股骨颈1值,血清BGP低于正常对照组,但股骨颈BMD、血清AKP、尿NTX较正常对照组差异未达统计学意义;SLE治疗组的腰椎、股骨颈BMD与T值均显著低于SLE初诊组.SLE组的骨质疏松及骨量减少率分别为6.74%、16.85%.结论 绝经前SLE患者较同年龄正常女性易发生骨质疏松,血清BGP和腰椎骨密度可能较早反映骨质疏松的发生.     

绝经后女性2型糖尿病患者骨密度影响因素的因子分析 黄海凤 邓小戈

目的 首次利用因子分析法对绝经后女性2型糖尿病(T2DM)患者骨密度(BMD)的有关因素进行分析,并重新评价BMD的影响因素.方法 ①收集416例绝经后T2DM患者的临床、生化和特殊检查资料作回顾性分析,采用SPSS18.0进行因子分析,提取公因子并计算因子得分.②按BMD分为正常骨密度、低骨量、骨质疏松3组,比较因子得分.结果 ①通过因子分析从原始指标中提取出3个公因子,分别代表体重指数和胰岛素抵抗因子、增龄和肾功能因子、脂代谢因子.②3组间3个公因子的得分存在显著性差异.结论 影响绝经后女性T2DM患者BMD的3大主要因子是体重指数和胰岛素抵抗因子,增龄和肾功能因子,以及脂代谢因子.     

Suppressed bone turnover was associated with increased osteoporotic fracture risks in non-obese postmenopausal Chinese women with type 2 diabetes mellitus

Summary

We found that type 2 diabetes mellitus (T2DM) was associated with increased fracture risks in non-obese postmenopausal Chinese women, and suppressed bone turnover might be the underlying mechanism. This is the first study evaluating and explaining the association of T2DM with osteoporotic fracture in Chinese population with such high homogeneity.

Introduction

The aim of this study was to investigate the association of T2DM with osteoporotic fracture in postmenopausal Chinese women.

Methods

One thousand four hundred ten postmenopausal women were included and stratified into non-obese population [body mass index (BMI)?<?25 kg/m²] and obese population (BMI?≥?25 kg/m²). Each type of population was classified into diabetes group, impaired fasting glucose (IFG) group, and normal glucose group. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Serum C-terminal telopeptide of type I collagen (β-CTX) and serum N-amino terminal prepeptide of type 1 procollagen (P1NP) were quantified. Vertebral fractures (VFs) and non-VFs were assessed by vertebral X-ray and questionnaire, respectively.

Results

Comparing to normal glucose group, diabetes group and IFG group both had lower levels of P1NP and β-CTX, despite population types. Despite having non-decreased BMD, non-obese diabetic patients had higher risks of total fracture and VF than BMI-matched normal glucose subjects (both P?<?0.05). Non-obese population was further classified by a mean value of P1NP or β-CTX. Non-obese diabetic patients with low P1NP or high β-CTX had higher fracture risks (both P?<?0.05), comparing to non-obese normal glucose subjects with high P1NP or high β-CTX, respectively.

Conclusions

Type 2 diabetic patients had suppressed bone turnover, which might explain the increased fracture risks, independent of BMD. IFG patients might also have poor bone quality and need early prevention.     

Higher serum uric acid is associated with higher bone mass, lower bone turnover, and lower prevalence of vertebral fracture in healthy postmenopausal women

Summary

Higher serum uric acid (UA) was associated with higher bone mass, lower bone turnover, and lower prevalence of vertebral fracture in postmenopausal women. Furthermore, UA suppressed osteoclastogenesis and decreased production of reactive oxygen species in osteoclast precursors, indicating UA may have beneficial effects on bone metabolism as an antioxidant.

Introduction

UA is known to play a physiological role as an antioxidant, and oxidative stress has detrimental effects on bone metabolism. In the present study, we investigated the association of serum UA level with the osteoporosis-related phenotypes and its direct effect on bone-resorbing osteoclasts using in vitro systems.

Methods

This is a large cross-sectional study, including 7,502 healthy postmenopausal women. Bone mineral density (BMD) and serum UA concentrations were obtained from all subjects. Data on bone turnover markers and lateral thoracolumbar radiographs were available for 1,023 and 6,918 subjects, respectively. An in vitro study investigated osteoclastogenesis and reactive oxygen species (ROS) levels according to UA treatment.

Results

After adjusting for multiple confounders, serum UA levels were positively associated with BMD at all sites (all p?<?0.001). Compared with the participants in the highest UA quartile, the odds for osteoporosis were 40 % higher in those in the lowest quartile. The serum UA levels were inversely related to both serum C-terminal telopeptide of type I collagen and osteocalcin levels (p?<?0.001 and p?=?0.004, respectively). Consistently, subjects with vertebral fracture had lower serum UA levels, compared with those without it (p?=?0.009). An in vitro study showed that UA decreased osteoclastogenesis in a dose-dependent manner and reduced the production of ROS in osteoclast precursors.

Conclusion

These results provide epidemiological and experimental evidence that serum UA may have a beneficial effect on bone metabolism as an antioxidant in postmenopausal women.     

Quantitative ultrasound and vertebral fractures in patients with type 2 diabetes

Patients with type 2 diabetes (T2DM) are known to have increased risks of femoral neck and vertebral fractures, although their bone mineral density (BMD) is normal or even slightly increased compared to non-DM controls. This observation suggests that bone fragility not reflected by BMD, possibly deterioration of bone quality, may participate in their fracture risks. Quantitative ultrasound (QUS), unlike BMD, could possibly evaluate bone quality, especially the microarchitecture, and therefore may be useful for assessing fracture risk in T2DM. To test this hypothesis, we measured calcaneal QUS as well as BMD at the lumbar spine, femoral neck, and 1/3 radius in 96 women (mean age 66.6 years old) and 99 men (64.7 years old) with T2DM, and examined their associations with prevalent vertebral fractures (VFs). Calcaneal QUS was performed by CM-200 (Elk Corp., Osaka, Japan), and speed of sound (SOS) values were obtained. BMD was measured by QDR4500 (Hologic, Waltham, MA). In T2DM patients, VFs were found in 33 and 45 subjects in women and men, respectively. When compared between subjects with and without VFs, there were no significant differences in values of SOS or BMD at any site between the groups in either gender. The distribution of SOS as a function of age showed that those with VFs were scattered widely, and there were no SOS thresholds for VFs in either gender. Logistic regression analysis adjusted for age and BMI showed that either SOS or BMD was not significantly associated with the presence of VFs in either gender. These results show that QUS as well as BMD are unable to discriminate T2DM patients with prevalent VFs from those without VFs. It seems necessary to seek other imaging modalities or biochemical markers evaluating bone fragility and fracture risk in T2DM.     

定量CT对2型糖尿病性骨质疏松的诊断意义

2型糖尿病(type 2 diabetes mellitus, T2DM)通过多种因素影响骨微结构和骨密度,导致骨强度下降,骨折风险增加。定量CT(quantitative computed tomography, QCT)测定三维体积骨密度(volume bone mineral density, vBMD)优于双能X线吸收法(dual energy X-ray absorptiometry, DXA)测定的面积骨密度(area bone mineral density, aBMD)对T2DM患者骨折风险评估,还能发现松质骨的结构改变、皮质骨多孔性结构,对骨量细微改变具有高敏感性。将QCT与有限元分析法结合,通过骨密度、骨组织结构同时分析骨应力来评价骨强度,对T2DM患者骨折风险的预测更有价值。     

新疆2型糖尿病绝经后女性LRP5rs41494349、rs2306862位点基因多态性及突变与骨代谢的关系

目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)绝经后女性LRP5rs41494349、rs2306862位点基因多态性及突变与骨代谢的关系。方法收集新疆绝经后汉族女性资料,根据血糖及骨密度(bone mineral density,BMD)分为4组:糖耐量正常伴骨量正常组(A组)、T2DM伴骨量正常组(B组)、糖耐量正常伴骨量异常组(C组)、T2DM伴骨量异常组(D组)。检测各临床指标,测定LRP5rs41494349、rs2306862位点基因型。结果①与A组相比,B组、D组FPG、HbA1c%升高,C组、D组TG、BMD(L1~4)、BMD(股骨颈)降低(P<0.05)。②rs2306862位点,突变型(CT/TT)与野生型(CC)相比,B组P升高,D组BMD(L1~4)、P降低(P<0.05);rs41494349位点,突变型(AG/GG)与野生型(AA)相比,D组的BMD(L1~4)降低(P<0.05)。③多元线性回归分析显示,绝经年限、体质量指数是BMD(L1~4)及BMD(股骨颈)的影响因素,TG是BMD(L1~4)的影响因素,两位点的基因多态性是BMD(股骨颈)的影响因素。结论LRP5rs41494339、rs2306862位点基因多态性及突变通过影响BMD及骨代谢指标,可能参与了绝经后女性的T2DM合并骨质疏松的发生和发展。     

乌鲁木齐地区维族、汉族绝经后糖尿病患者骨代谢结果分析

目的探讨新疆维族、汉族绝经后2型糖尿病(T2DM)骨密度变化及骨代谢的差异,为临床骨质疏松症的诊治工作提供进一步依据。方法选取2008年1月-2013年12月于新疆生产建设兵团医院内分泌科住院的维吾尔族、汉族女性且已绝经2型糖尿病患者共405人,按族别分为两组,记录并分析患者血清钙、磷、碱性磷酸酶、骨钙素、25羟维生素D3变化,并进行骨密度测定。结果维吾尔族组血清钙略低于汉族组,但无统计学差异,血清磷水平差异亦不显著;维吾尔族组血清碱性磷酸酶、25羟维生素D3水平均低于汉族组,P0.05,维吾尔族组血清骨钙素高于汉族组,P0.05;按绝经年限不同统计:维吾尔族女性骨量减低比例较高,发生骨质疏松的比例维吾尔族组亦高于汉族组,骨密度正常组汉族比例明显高于维吾尔族。两组股骨颈、股骨大转子、腰椎骨密度值比较,维吾尔族组骨密度值均低于汉族组,在维吾尔族股骨颈及腰椎骨密度下降更明显,但无统计学差异。结论维吾尔族绝经后糖尿病患者骨代谢水平较汉族下降明显。