Effect Of Metformin On Bone Mass And Fracture Risk In Elderly Patients With Type 2 Diabetes Mellitus

Objectives To explore the effect of metformin on bone mass and fracture risk in elderly patients with Type 2 diabetes mellitus(T2DM).Methods A total of 648 elderly patients with type 2 diabetes who received treatment in The Affiliated Hospital of North China University of Science and Technology from June2017 to May 2020 were enrolled.Subjects were divided into a metformin group and a control group based on whether they had used metformin continuously for more than 1 year(inclusive)during their type 2 diabetes treatment.Meanwhile,subjects in the metformin group were divided into low-dose group,medium-dose group and high-dose group according to the treatment dose of metformin.1 compare the difference of bone mass between metformin group and control group;The differences of bone mass between the low-dose group,the medium-dose group and the high-dose group were analyzed.2.The fracture risk of low bone mass study subjects in metformin group and control group was calculated and compared,and the difference of fracture risk among low bone mass study subjects in low dose group,medium dose group and high dose group was analyzed.The difference of fracture rate between metformin group and control group was calculated and compared,and the difference of fracture rate between metformin group,medium dose group and high dose group was analyzed.Results 1 A total of 648 subjects were collected in this study.There were 374 subjects in metformin group and 274 subjects in control group.Two groups in gender,age,systolic pressure,diastolic pressure,glycosylated hemoglobin,course of type 2 diabetes,body mass index,serum calcium,serum phosphorus product of ion,serum calcium,phosphorus,total cholesterol lipoprotein cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,triglycerides,comparison,there were no statistically significant difference(P>0.05).The data are comparable.2 There were 46 subjects with normal bone mass in metformin group,accounting for 12.30% of metformin group;157 patients with low bone mass were studied,accounting for 41.98% of metformin group.A total of 171 patients with osteoporosis were studied,accounting for 45.72% of metformin group.There were 32 subjects with normal bone mass in the control group,accounting for 11.68% of the total.There were 86 patients with low bone mass,accounting for 31.39% of the control group.A total of 156 patients with osteoporosis were studied,accounting for 56.93% of the control group.The composition of subjects with different bone mass in metformin group and control group was different,and the difference was statistically significant(P<0.05).Further,chisquare cutting was carried out for the composition of subjects with different bone mass in the two groups.The analysis results showed that the difference between the subjects with low bone mass in the two groups was the largest compared with other subjects with corresponding bone mass.3 There were 85 subjects in the low-dose group,including 12 subjects with normal bone mass,accounting for 14.12% in the low-dose group.There were39 patients with low bone mass,accounting for 45.88% in the low-dose group.Osteoporosis was studied in 34 patients,accounting for 40.00% of the low-dose group.There were 153 subjects in medium-dose group,including 19 subjects with normal bone mass,accounting for 12.42% in medium-dose group.There were 60 patients with low bone mass,accounting for 39.22% in the medium-dose group.Seventy-four patients with osteoporosis were studied,accounting for 48.37% of the medium-dose group.There were 136 subjects in the high-dose group,including 14 subjects with normal bone mass,accounting for 10.29% of the highdose group.There were 58 patients with low bone mass,accounting for 42.65% of the highdose group.There were 64 patients with osteoporosis,accounting for 48.06% of the highdose group.There was no significant difference in the composition of different bone mass(normal bone mass,low bone mass and osteoporosis)among the three groups(P>0.05).4The risk of systemic fracture was 9.5%(8.3%,10.2%)in 157 patients with low bone mass in metformin group,and 1.7%(0.8%,2.0%)in hip fracture.A total of 86 subjects with low bone mass in the control group had a 10.6%(8.4%,11.0%)risk of major systemic fractures,including a 1.9%(0.9%,2.3%)risk of hip fractures.Non-parametric test was used to compare the risk of fractures in major parts of the whole body of the subjects with low bone mass in the two groups,and there was no statistical significance(P>0.05).However,the risk of hip fracture was lower in the metformin group than in the control group,and the difference was statistically significant(P<0.05).5 There were 39 patients with low bone mass in the low-dose group,and the risk of systemic fractures was 9.4%(8.0%,9.9%),among which the risk of hip fractures was 1.8%(0.9%,2.1%).Sixty patients with low bone mass in the medium-dose group had a 9.5%(8.4%,10.3%)risk of major systemic fractures,including a1.7%(0.8%,2.0%)risk of hip fractures.A total of 58 subjects with low bone mass in the high-dose group had a 9.5%(8.3%,10.0%)risk of major systemic fractures,including 1.7%(0.7%,2.0%)risk of hip fractures.There was no significant difference in the risk of systemic fractures and hip fractures among the three groups with low bone mass(P>0.05).6 In metformin group,the incidence of fractures in major parts of the body was 7.02%,including5.26% of hip fractures.In the control group,the incidence of fractures in major parts of the body was 9.62%,and the incidence of hip fractures was 7.09%.Chi-square test was used to analyze the non-fracture and fracture composition of osteoporosis subjects in metformin group and control group,and there was no statistical significance(P>0.05).There was no significant difference in fracture and hip fracture composition between metformin group and control group(P>0.05).7 The incidence of fractures in major parts of the whole body was15.15% in the low-dose group,12.12% in the medium-dose group and 10.94% in the highdose group,among which the incidence of hip fractures was 8.33%,4.05% and 4.69%.Chisquare test was further used to compare the occurrence of fracture and fracture composition among the above three groups,and there was no significant difference(P>0.05).There was no significant difference in hip fracture composition and fracture occurrence among the three groups(P>0.05).Conclusions 1 Metformin can significantly reduce bone loss in elderly patients with low bone mass in type 2 diabetes mellitus,and this effect is independent of dose of metformin.2Metformin significantly reduced the risk of hip fracture in elderly patients with low bone mass type 2 diabetes,regardless of dose.Figure 2;Table 7;Reference 100...