| Background and Purpose:With the increasing incidence of type 2 diabetes and osteoporosis,more and more attention has been paid to the research on type 2 diabetes and bone metabolism.As a two-way regulating factor of bone metabolism,vitamin K2 has been proved to significantly increase bone mineral density and reduce the risk of fracture in patients with osteoporosis.However,there is no clear conclusion on the relationship between vitamin K2 and type 2 diabetes.Therefore,the purpose of this study was to investigate the relationship between serum vitamin K2 concentration,blood glucose parameters and bone mineral density in patients with type 2 diabetes mellitus,and the effect of vitamin K2 on the risk of osteoporosis and the risk grade of fragile fracture in patients with type 2 diabetes mellitus.Methods:A total of 160 T2 DM patients who were hospitalized in the Endocrinology Department of the Second Affiliated Hospital of Nanchang University from November 2020 to November 2021 were collected.The general data of all subjects(age,sex,height,weight,course of diabetes,systolic blood pressure,diastolic blood pressure,smoking history,drinking history,bone fracture history,parents’ bone fracture history,etc.)were collected by questionnaire.Blood samples were collected for routine biochemical indexes(albumin,eGFR,SCr,SUA,ACR,TC,TG,LDL-C,HDL-C,Ca,P),blood glucose related indexes(diabetes cycle,FPG,2hPG,FCP,HOMA2-IR),bone metabolism indexes(P1NP,β-CTX,BALP,BGP,25(OH)D3,PTH)and vitamin K2 concentration.All subjects were examined by Dual-energy X-ray absorptiometry for bone mineral density.According to whether the glycosylated hemoglobin is more than 7,the subjects were divided into HbA1c>7group and HbA1 c ≤ 7 group;according to bone mineral density,they were divided into normal bone mass group,osteopenia group and osteoporosis group;according to FRAX score,they were divided into high risk group and low-medium risk group of fragile fracture.Methods of analyzing data are as follows: 1)comparing the differences of all research indexes among the above groups.2)analyzing the correlation between vitamin K2 and bone parameters,blood glucose parameters and routine biochemical indexes.3)analying the effect of vitamin K2 on the risk of osteoporosis and the risk grade of brittle fracture by Logistic regression.Results:1.Comparison of vitamin K2 concentration and bone parameters between different blood glucose control levels in patients with T2 DM.In patients with type 2 diabetes,the concentration of vitamin K2,L2-L4.BMD,body weight,BMI,ACR,TG,LDL-C,FPG,2hPG and HbA1 c in HbAlc ≤ 7 group were significantly lower than those in HbAlc > 7 group(P < 0.05),while FCP was significantly higher than that in HbAlc > 7 group(P < 0.05).There was no significant difference in age,sex,SBP,DBP,smoking history,drinking history,albumin,Cr,eGFR,uric acid,total cholesterol,HDL-C,diabetes cycle,HOMA2-IR,PINP,β-CTX,BALP,BGP,25(OH)D3,PTH,corrected Ca,P,HIP.BMD,FN.BMD,neck angle,HAL,MOF,HF,bone fracture history and parental fracture history between the two groups(P > 0.05).2.Comparison of vitamin K2 concentration and bone parameters between different bone mineral density stratification in patients with T2 DM.In patients with type 2 diabetes,the concentration of vitamin K2,body weight,BMI,smoking history,drinking history,eGFR,L2-L4.BMD,HIP.BMD,FN.BMD and HAL in osteoporosis group were significantly lower than those in osteopenia group and normal bone mass group(P < 0.05),while age,proportion of women,β-CTX,BALP,MOF,HF and bone fracture history were significantly higher than those in osteopenia group and normal bone mass group(P < 0.05).There was no significant difference in blood glucose related indexes,blood pressure(SBP,DBP),routine biochemical indexes,ACR,PINP,BGP,25(OH)D3,PTH,neck axis angle and parental fracture history among the three groups(P > 0.05).3.Comparison of vitamin K2 concentration and bone parameters between different risk of brittle fracture in patients with T2 DM.In patients with type 2 diabetes,the age,proportion of women,HDL-C,P1 NP,BGP,MOF,HF,bone fracture history and parental fracture history in the high risk group were significantly higher than those in the low-medium risk group of fragile fracture(P < 0.05).The concentration of vitamin K2,body weight,BMI,albumin,eGFR,HbA1 c,L2-L4.BMD,HIP.BMD and FN.BMD in the high risk group were significantly lower than those in the low-medium risk group(P < 0.05).There was no significant difference in systolic blood pressure,diastolic blood pressure,smoking history,drinking history,SCr,SUA,ACR,TC,TG,LDL-C,diabetes cycle,FPG,2hPG,FCP,HOMA2-IR,β-CTX,BALP,25(OH)D3,PTH,corrected Ca,P,neck angle and HAL between the two groups(P > 0.05).4.Correlation between vitamin K2 and bone mineral density and bone metabolism in patients with T2 DM.In patients with type 2 diabetes,vitamin K2 was positively correlated with BMI,L2-L4.BMD,FN.BMD and HAL,and negatively correlated with age,sex,SBP,BALP,adjusted Ca,MOF and HF(P < 0.05).After adjusting for body weight,vitamin K2 was still positively correlated with L2-L4.BMD and FN.BMD(P < 0.05),but not with hip.BMD(P > 0.05).After adjusting for age,sex,BMI and 25(OH)D3,vitamin K2 was positively correlated with HAL,and negatively correlated with BALP and corrected Ca(P < 0.05).There was no significant correlation between vitamin K2 and routine biochemical indexes and blood glucose related index(P > 0.05).5.Effect of vitamin K2 on the risk of osteoporosis.In patients with type 2 diabetes,vitamin K2 was significantly negatively correlated with the risk of osteoporosis(P for trend < 0.05);with each increase in1ng/ml,the relative risk of osteoporosis decreased by 16%(RR0.84 [95% CI0.71-0.99]).After adjusting for age,sex,systolic blood pressure,corrected calcium,serum phosphorus,serum creatinine,albumin,high density lipoprotein cholesterol,low density lipoprotein cholesterol,triglyceride,smoking history,drinking history,bone fracture history,parental fracture history(model 3),the risk of osteoporosis in the part with the highest concentration of vitamin K2(Q4)was 85% lower than that in the part with the lowest concentration of vitamin K2(Q1)(RR 0.15 [95% CI0.02-0.90]).6.Effect of vitamin K2 on the risk grade of brittle fracture.There was a significant negative correlation between vitamin K2 and the risk of fragile fracture in patients with type 2 diabetes(P for trend < 0.05).With each increase in 1ng/ml,the relative risk of transition from low-medium risk of fragile fracture to high risk of brittle fracture decreased by 25%(P < 0.05).After adjusting for age,sex,SBP,HDL-C,LDL-C,2hPG,FCP,P1 NP,β-CTX,PTH,25(OH)D3,adjusted for Ca,P,smoking,drinking,and parental fracture history(model 3),the risk decreased by 36%(P < 0.05).The risk of fragile fracture in the part with the highest concentration of vitamin K2(Q4)was 98% lower than that in the part with the lowest concentration of vitamin K2(Q1)(RR 0.02 [95% CI 0.00-0.28]).Conclusion:Vitamin K2 is an independent protective factor for the risk of osteoporosis and brittle fracture in the middle-aged and elderly patients with type 2 diabetes. |
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