| Objective1To observe the morbidity of osteopenia and osteoporosis in patients with type2diabetes mellitus, analysis the influence of glucose metabolism on bone turnover biochemical markers and bone mineral density;2To observe serum25(OH)D level in T2DM patients, analysis the influence of25(OH)D on glucose metabolism, renal function, and bone turnover biochemical markers and bone mineral density;3FRAX was used in this paper to compare the10-year probability of a maj or osteoporotic fracture and hip fracture risk in T2DM patients and non-diabetic patients, in order to evaluate the effectivity of FRAX to predict fracture risk in T2DM patients.Materials and Methods11636T2DM patients admitted in Endocrinology Department of Zhongshan Hospital, Fudan University were included in the study from Oct.2009to Jan.2013. The related data were collected for all patients (refer to Appendix Ⅱ), and dual-energy X-ray absorptiometry were used to measure the femoral neck, total hip and lumbar spine bone mineral density.(1) Observe the morbidity of osteopenia and osteoporosis in T2DM patients;(2) Grouped according to HbAlc, compare the bone metabolism under different levels of glycemic control in male and female patients respectively;(3) Grouped according to serum25(OH)D, compare the glucose metabolism, renal function, bone turnover biochemical markers and bone mineral density under different levels of25(OH)D in male and female patients respectively, analysis the influence of25(OH)D on glucose metabolism, renal function and bone metabolism.2682T2DM patients(40-49years old) admitted in Endocrinology Department of Zhongshan Hospital, Fudan University were collected as type2diabetes mellitus group(T2DM group);595cases without type2diabetes mellitus from physical examination center of Zhongshan Hospital, Fudan hospitalized were collected as control group. The related data were collected for all patients (refer to Appendix Ⅲ); and the bone mineral density was measured.(1) Compare the bone mineral density between T2DM patients and control group. Analyze the risk of abnormal bone mass between T2DM patients and control group.(2) Compare the FRAX fracture risk between T2DM patients and control group; analyze the risk of high fracture risk in T2DM patients to verify the effectivity of FRAX to predict fracture risk in T2DM patients.Results11,636cases of type2diabetic patients were included in the analysis (male941, female695), with an average age of (59.16±12.53) years old. In the overall1,636patients, normal bone mass has553cases, which accounts for33.8%; osteopenia has764cases, which accounts for46.7%, osteoporosis has319cases, which accounts for19.5%. The morbidity of abnormal bone mass in women is higher than men (P <0.001). Grouped according to age, it is found that the morbidity of abnormal bone mass increased with age.2Patients were divided by tertiles of HbAl c. Along with the rise of HbAl c, the ALP gradually increased and PTH, OCN, P1NP gradually decreased with statistically significant. In addition, in female patients, along with the rise of HbA1c, serum phosphate, calcium-phosphate product, and femoral neck BMD and total hip BMD decreased with statistically significant.3Due to the detection of25(OH)D method changed around April23th,2012, only545cases after April23th,2012were analyzed to explore the relationship between25(OH)D and glucose metabolism, renal function and bone metabolism. In this study, the average level of serum25(OH)D is (41.28±17.05)nmol/1, in male group the average level of serum25(OH)D is (43.39±18.12)nmol/1, in female group is (38.23±14.90)nmol/l, which indicates that diabetic patients have high morbidity of vitamin D deficiency, especially in female group. Correlation analysis indicates that25(OH)D is negatively correlated to HbAlc,24h UAER, urine ACR and PTH, positively correlated to serum calcium and femoral neck BMD. Patients were divided by tertiles of25(OH)D. Along with the rise of25(OH)D, FPG, HbA1c,GA,24h UAER, urine ACR have a trend to decrease, especially in female patients with statistically significant.4Bone mineral density in T2DM patients is higher than control group, especially in male group(60-70years old) and female group(50-60years old), the tendency is statistically significant. The risk of abnormal bone mass for T2DM patients is lower than control group, after adjusting for age and gender, OR=0.642(P<0.001).Compared with control group, according to the FRAX fracture risk prediction, the10-year probability of a major osteoporotic fracture and hip fracture in T2DM patients are lower, especially in male group(60-70years old) and female group(50-60years old), the tendency is statistically significant. Patients were divided into high fracture risk group and low fracture risk group by75%of FRAX score (the10-year probability of a major osteoporotic fracture≥2.6%, hip fracture≥0.7%), in T2DM patients, the risk of high risk for osteoporotic fracture and hip fracture are both lower than control group, after adjusting for age and gender, OR=0.623(P=0.002) and0.653(P=0.007).Conclusion1For T2DM patients, as HbA1c increases, markers of bone formation and resorption decrease, bone turnover has a decreaing trend.2Vitamin D deficiency widely exists in T2DM patients, and vitamin D deficiency of women is more severe than that of men.3Vitamin D level is negatively correlated to HbAlc,24h UAER and urine ACR, which suggests that elevated vitamin D level may help to improve blood glucose control and reduce the risk of diabetic nephropathy to some extent.4According to the FRAX fracture risk prediction, the10-year probability of a major osteoporotic fracture and hip fracture in T2DM patients is lower than control group, and the risk of high fracture risk is lower. This indicates that FRAX may underestimate the10-year probability of the major osteoporotic fracture risk and hip fracture risk for T2DM patients. Thus, FRAX may not be suitable for assessment of the major osteoporotic fracture risk and hip fracture risk for T2DM patients. |
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