Correlation Analysis Of Bone Mineral Density With Abdominal Fat And Metabolic Indexes In Type 2 Diabetics

Objective:To explore the correlation between bone mineral density and abdominal fat and metabolic indexes in patients with type 2 diabetes,and to provide new ideas and methods for the prevention and treatment of patients with T2DM and osteoporosis.Methods:A total of 236 T2DM patients with over 40 years old who were hospitalized in the Endocrinology Department of the First Affiliated Hospital of Nanchang University from July 2020 to December 2020 were selected.Lumbar(L_1³)bone mineral density and abdominal fat area were measured by quantitative computed tomography.Firstly,according to the average BMD,the patients were divided into normal bone mass group（84 cases）,low bone mass group（109 cases）and osteoporosis group（43 cases）.Secondly,male and female patients were divided into3 groups according to the average BMD,respectively.Compare the age,course of diabetes,body mass index,waist-to-hip ratio,fasting plasma glucose,glycosylated hemoglobin A1c,fasting C-peptide,triglyceride,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,uric acid,blood calcium,blood phosphorus,parathyroid hormone,cross linked C-telopeptideβspecial sequence of type I collagen,total amino-terminal procollagen of type I collagen,25-hydroxyvitamin D,interleukin 1β（The main secretion form of IL-1）,interleukin 6,tumor necrosis factor alpha,C-reactive protein,abdominal visceral fat area and abdominal subcutaneous fat area,analyze their relationship with BMD.Thirdly,analyze the differences in WHR,BMD,AVF and SAF in each group by BMI.Finally,women were grouped by age to analyze whether there were differences in BMI,WHR,BMD,AVF and SAF.Results:1.The distribution of BMD in T2DM patients:T2DM with normal bone mass,low bone mass and OP accounted for 35.59%,46.19%and 18.22%of all selected subjects,respectively.The incidence of OP in women was higher than that in men,and the difference was statistically significant（P<0.05）.2.In the comparison of the indexes of the BMD group,the age of low bone mass group was significantly older than that of normal bone mass group and osteoporosis group（P<0.05）,the age and course of diabetes in osteoporosis group was significantly older than that of normal bone mass group（P<0.05）.The TG of the osteoporosis group was significantly lower than that of the normal bone mass group and low bone mass group（P<0.05）,the TG of the normal bone mass group was significantly higher than that of the low bone mass group（P<0.05）.Theβ-CTX and TP1NP in osteoporosis group were significantly higher than those in normal bone mass group（P<0.05）,and 25（OH）D in low bone mass group was significantly higher than that in normal bone mass group and osteoporosis group（P<0.05）.The TNF-αin low bone mass group was significantly higher than that in normal bone mass group（P<0.05）,and there was no statistically significant difference in BMI,WHR,FPG,HbA1c,FCP,TC,HDL-C and LDL-C,UA,P,Ca and PTH,CRP,IL-1β,IL-6,AVF and SAF among the three groups（P>0.05）.3.In the BMI group,the normal weight group,overweight group and obese group accounted for 53.39%,36.86%,and 9.75%of all the included subjects,respectively.Among the 126 subjects in the normal weight group,only 14 cases（11.11%）had AVF<80cm²,and the remaining 112 cases（88.89%）had AVF greater or equal to 80cm².Normal AVF subjects accounted for 5.93%of all subjects,and94.07%of subjects had excessive visceral fat.The BMI,WHR,AVF and SAF of the overweight group and the obese group were significantly higher than those of the normal weight group.The BMI,WHR,AVF and SAF of the obese group were significantly higher than those of the overweight group（P<0.05）.There was no statistically significant difference in BMD among the three groups（P>0.05）.4.The results of correlation analysis showed that AVF was positively correlated with age,BMI,WHR,FCP,TG,CRP,IL-1β,IL-6,TNF-αand SAF（P<0.05）,and negatively correlated with HDL-C（P<0.05）.There was no significant correlation with the course of diabetes,FPG,HbA1c,TC,LDL-C and P（P>0.05）.SAF was positively correlated with BMI,WHR,TG,CRP,TNF-α,AVF and P（P<0.05）.There was no significant correlation with age,course of diabetes,FPG,HbA1c,FCP,TC,LDL-C,HDL-C,IL-1βand IL-6（P>0.05）.After adjusting for confounding factors,AVF was positively correlated with BMI,age,WHR and IL-1β（P<0.05）,and negatively correlated with gender（P<0.05）.SAF was positively correlated with BMI,gender,TG and AVF（P<0.05）),and negatively correlated with HbA1c（P<0.05）.5.Ordered multiple classification logistic regression analysis showed that female,age,course of diabetes andβ-CTX are risk factors for OP in T2DM patients,but P is a protective factor.Conclusion:1.There was no correlation between the average BMD of the lumbar spine(L_1³)and abdominal fat in type 2 diabetic patients measured by QCT.2.The average BMD of the lumbar spine(L_1³)of type 2 diabetic patients determined by QCT is negatively correlated with adipocytokines（IL-1β,IL-6,TNF-α）,age,course of diabetes,β-CTX and TP1NP.3.Female,age,course of diabetes,andβ-CTX are independent risk factors for OP in patients with T2DM,and a moderately increased P within the normal reference range may be a beneficial factor in inhibiting the occurrence of OP.4.The indexes affected by AVF are significantly more than those of SAF,suggesting that AVF has a greater impact on metabolism than SAF.5.The accuracy of BMI as a measure of obesity is far lower than AVF.If obesity is diagnosed by BMI,it may lead to missed diagnosis of most patients with normal BMI but excessive visceral fat.