| Objective: By reviewing the case data of geriatric patients with type2 diabetes mellitus who were hospitalized in the Department of Geriatrics and the Department of Endocrinology of the University of Traditional Chinese Medicine,Shandong Province,we analyzed the risk factors associated with bone mass changes in elderly patients with type 2 diabetes mellitus combined with the distribution pattern of Chinese medicine evidence patterns,explored the pathogenesis of osteoporosis in the elderly with type 2 diabetes mellitus,and provided theoretical basis for clinical prevention and treatment.Methods: 306 inpatients who met the inclusion and exclusion criteria in the Department of Geriatrics and the Department of Endocrinology,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,from June 2017 to June 2022 were selected as the study population,and the patients’ gender,age,and duration of diabetes,TCM type,glycated hemoglobin(Hb Alc),25-hydroxyvitamin D(25(OH)VD),β-cross enzyme(β-CTX),osteocalcin(OC),type I collagen propeptide(PINP)were counted separately through the United System.Recorded in the Excel table,using SPSS25.0 statistical software for statistical analysis.In univariate analysis,chi-square tests are used for counting data and α segmentation is used for pairwise comparisons.Analysis of variance or rank sum test were used for measurement data,and Bonferroni or Tamhane T2 test was used for pairwise comparison;Multivariate analysis uses logistic regression analysis.Results:1.Analysis of general data(1)Gender: 52.9% of males and 47.1% of females in the group with normal bone mass;52.9% of males and 47.1% of females in the group with reduced bone mass;44.1% of males and 55.9% of females in the group with osteoporosis.There was no statistically significant difference between the sexes of different bone mass sub-groups(P>0.05).(2)Age groups: 60-69 years old,the proportion of the normal bone mass group(45.3%)was higher than that of the reduced bone mass group(40.1%)and the osteoporosis group(14.6%);70-79 years old,the proportion of the reduced bone mass group(53.2%)was higher than that of the osteoporosis group(42.4%)and the normal bone mass group(4.3%);over 80 years old,the proportion of the osteoporosis group(76.7%)was higher than that of the reduced bone mass The difference between the different bone mass groups and the two comparisons was statistically significant(p<0.001).(3)Mean age: The mean age of the osteoporosis group(75.25±6.38 years)was higher than that of the reduced bone mass group(70.82±4.78 years),and the mean age of the reduced bone mass group was higher than that of the normal bone mass group(65.19±2.88 years),with statistically significant differences between the different bone mass groups and between the two comparisons(P<0.001).2.Analysis of the duration of diabetes mellitus: the mean duration of disease was longer in the osteoporosis group(10(7.88,15.13)years)than in the reduced bone mass group(8(5.5,12.38)years)and in the normal bone mass group(6.85±2.68 years),and the mean duration of disease was longer in the reduced bone mass group than in the normal bone mass group,and the differences were statistically significant(P<0.05;P<0.001;P<0.05).3.Analysis of laboratory indicators(1)There were statistically significant differences in Hb Alc between the different bone mass sub-groups(P<0.001).Two-by-two comparison: the mean Hb Alc in the osteoporosis group was higher than that in the osteopenia group and the normal bone mass group(both P<0.001),and the mean Hb Alc in the osteopenia group was higher than that in the normal bone mass group(P<0.05).(2)Statistically significant differences existed between the different bone mass subgroups on 25(OH)VD(P<0.05)and on β-CTX,OC and PINP(P<0.001).Two comparisons: mean 25(OH)VD was lower in the osteoporotic and osteopenia groups than in the normal bone mass group(P<0.001;P<0.05),mean 25(OH)VD was lower in the osteoporotic group than in the osteopenia group,and the difference was not statistically significant(P>0.05);mean β-CTX was higher in the osteoporotic and osteopenia groups than in the normal bone mass group(P<0.001;P< 0.05);mean β-CTX in the osteoporosis group was higher than that in the bone loss group,the difference was not statistically significant(P>0.05);mean OC in the osteoporosis group was lower than that in the bone loss group and the bone loss normal group(P<0.05;P<0.001),OC level in the bone loss group was lower than that in the bone loss normal group(P<0.001);mean PINP in the osteoporosis group was higher than that in the bone loss group,the bone mass normal group,and the mean PINP of the bone mass reduction group was higher than that of the bone mass normal group(both P<0.001).4.Binary logistic regression analysis: age(OR=1.763,95% CI: 1.376-2.259),PINP(OR=2.329,95% CI: 1.679-3.231)and Hb Alc(OR=2.406,95% CI:1.008-5.747)were all risk factors for changes in bone mass in older adults with type 2 diabetes(P<0.001).factors(P<0.001;P<0.001;P<0.05).5.TCM syndrome analysis: distribution of TCM syndromes in different bone mass groups,normal bone mass group: Qi-Yin Two Deficiency Syndrome(36.8%)> Yin-Yang Two Deficiency Syndrome(29.4%)> Liver-Kidney Deficiency Syndrome(17.6%)> Qi-Deficiency Blood Stasis Syndrome(16.2%);reduced bone mass group: Qi-Yin Two Deficiency Syndrome(30.1%)> QiDeficiency Blood Stasis Syndrome(24.3%)> Yin-Yang Two Deficiency Syndrome(23.5%)> Liver-Kidney Deficiency Syndrome(22.1%);osteoporosis group:deficiency of liver and kidney(36.3%)> deficiency of qi and blood stasis(24.5%)> deficiency of qi and yin(22.5%)> deficiency of yin and yang(16.7%).There was a statistically significant difference in the distribution of liver and kidney deficiency evidence among the different bone mass subgroups(P<0.05),and no statistically significant difference in the distribution of qi-yin two deficiency evidence,yin-yang two deficiency evidence and qi-deficiency blood stasis evidence(P>0.05).Two comparisons: the proportion of liver and kidney deficiency evidence was higher in the osteoporosis group than in the bone loss group and normal bone mass group(both P<0.017);the proportion of liver and kidney deficiency evidence was higher in the bone loss group than in the normal bone mass group,but the difference was not statistically significant(P>0.017).Conclusion:1.Bone mass changes in elderly patients with type 2 diabetes mellitus were not related to gender but to age,and the older the age,the higher the probability of bone mass changes.2.Bone mass changes in elderly type 2 diabetic patients were correlated with the duration of diabetes.The average duration of disease in the osteoporosis group was longer than that in the osteopenia group and the normal bone mass group,and the average duration of disease in the osteopenia group was longer than that in the normal bone mass group.3.Bone mass changes in elderly type 2 diabetic patients were positively correlated with Hb Alc,and the degree of bone mass changes increased as Hb Alc increased.4.Bone volume changes in elderly type 2 diabetic patients were correlated with 25(OH)VD,OC,β-CTX and PINP.25(OH)VD and OC in the osteoporosis and osteopenia groups were lower than those in the normal bone volume group,and OC in the osteoporosis group was lower than that in the osteopenia group;β-CTX and PINP in the osteoporosis and osteopenia groups were higher than those in the normal bone volume group,and PINP in the osteoporosis group was higher than that in the osteopenia The osteoporosis group and the osteopenia group had higher PINP than the osteopenia group.5.The distribution pattern of TCM evidence of different bone mass in elderly type 2 diabetic patients: liver and kidney deficiency evidence was predominant in osteoporosis,followed by qi deficiency and blood stasis evidence,qi-yin and yin-yang deficiency evidence;qi-yin and blood stasis evidence was predominant in reduced bone mass,followed by qi deficiency and blood stasis evidence,yin-yang and liver and kidney deficiency evidence;qi-yin and blood deficiency evidence was predominant in normal bone mass,followed by yin-yang and yin-yang deficiency evidence,liver and kidney deficiency evidence and qi deficiency and blood stasis evidence.The distribution of liver and kidney deficiency evidence was different among different bone mass groups,and elderly type 2 diabetic patients with liver and kidney deficiency evidence were more likely to combine with osteoporosis.6.Logistic regression analysis showed that advanced age,poor glycemic control and elevated PINP were all risk factors for bone mass changes in elderly type 2 diabetic patients. |
PDF Full Text Request