| BACKGROUNDPostmenopausal osteoporosis（PMOP）is a systemic metabolic disease characterized by low bone mass and microstructural degeneration of bone tissue and increased vulnerability to bone fragility and fracture due to the decline of ovarian function and decreased estrogen level in postmenopausal women,resulting in bone resorption greater than bone formation[1].Clinical manifestations include pain around the body,spinal deformity,increased risk of osteoporotic fracture and a series of complications caused by fracture,which seriously threaten the physical and mental health of middle-aged and elderly postmenopausal women.Diabetic osteoporosis（DOP）is a serious and chronic complication of diabetes in the skeletal system,which is clinically manifested as systemic bone pain and even brittle fracture,seriously affecting the survival and quality of life of patients[2-3].Postmenopausal women with type 2 diabetes mellitus are at higher risk of osteoporosis and even fracture,with more severe severity and worse prognosis due to the dual effect of decreased estrogen level and high blood sugar.Therefore,active and effective measures should be taken to prevent and treat type 2 diabetes mellitus with postmenopausal osteoporosis in order to improve the quality of life,reduce disability rate and prolong life span.Zoledronate（Za）is a third-generation nitrogen-containing bisphosphonate for intravenous use and a powerful bone resorptive inhibitor.It has been confirmed by many domestic and foreign literatures that zoledronate has significant efficacy in the treatment of postmenopausal osteoporosis[4-9].However,zoledronate is rarely reported in the treatment of postmenopausal osteoporosis with type 2 diabetes mellitus.PURPOSETo evaluate the effect of zoledronate on bone mineral density（BMD）,related indexes of bone metabolism and fracture risk in type 2 diabetic patients with postmenopal osteoporosis,to provide more theoretical basis for zoledronate in the treatment of Type 2 diabetes Mellitus with postmenopal osteoporosis.METHODSRetrospective collection of Type 2 diabetes mellitus patients with postmenopal osteoporosis who were hospitalized in the Department of endocrinology and Department of orthopaedics from January 2018to December 2018 in the hospital electronic medical record system.A total of 49 eligible patients,aged 58-78 years,the mean age was（67.73±5.87）years,with a diabetes course of 8-12 years,the mean was（9.28±0.92）years,were screened out according to the intake criteria.The mean values of Hb A1c（6.6%-11.4%）and BMI（12.97-35.41kg/m2）were（8.15±1.10）%and（23.60±5.67）kg/m2.The 49 patients were divided into treatment group and control group,the conventional drug treatment（"calcitriol"and"calcium"）cases in control group,a total of 25 cases,in addition to conventional drugs,application of azole to phosphonic acid salt,100 ml:5 mg,annual cases in treatment group.Of the 49 cases,23 cases were complicated with fracture,15 cases in the treatment group and 8 cases in the control group.The treatment period for both groups was continuous 3 years.The bone mineral density（BMD）,β-collagen specific sequence of bone resorption markers（β-CTX）,tartrate-resistant Acid phosphatase-5b（TRACP-5b）,and 25-hydroxyvitamin D-3,blood calcium,blood phosphorus,blood creatininewere compared between the two groups before and after treatment,for the comparison of the indexes before and after treatment within the group,the difference met the normal distribution,using paired sample t-test,for the comparison of continuous variables between the groups,after Normality test and variance homogeneity test,the normal distribution was satisfied,and the independent-sample t-test was used,which was expressed as mean±standard deviation.The test result was P<0.05,that is to say,the test result was statistically significant.After 3 years of treatment,the treatment group and the control group were divided into two groups according to Hb Alc≤7.0%and Hb Alc>7.0%,respectively,the bone mineral density（BMD）,β-CTX,TRACP-5b and 25-hydroxyvitamin d 3（25-hydroxyvitamin d 3）were measured.The results were P<0.05,that is to say,the results were statistically significant,the correlation of Hb Alc with bone mineral density（BMD）,β-CTX,TRACP-5b and 25-hydroxyvitamin D-3 was analyzed by Pearson correlation analysis,in addition,the level of serum creatinine was monitored before and after treatment in both groups.Above data were processed by SPSS 25.0 statistical software;At the same time,the new fracture of the two groups during the 3-year treatment were compared and analyzed.RESULTS1.BMDBefore the treatment:the BMD of the femoral neck and the distal radius of the two groups had no significant difference before treatment（P>0.05）;After the treatment:The BMD of femoral neck and radius in the treatment group was significantly higher than that before treatment（P<0.05）;The BMD of femoral neck and radius in the control group had no significant change after treatment（P>0.05）,after 3 years of treatment,the BMD of the group with poor control of blood glucose was significantly lower than that of the group with good control of blood glucose.2.Bone resorption markersBefore the treatment:There was no significant difference inβ-CTX and TRACP-5b Acid phosphatase between the two groups（P>0.05）;After the treatment:The levels ofβ-CTX and TRACP-5b in the treatment group were significantly lower than that before treatment（P<0.05）,There were no significant changes in the control group（P>0.05）,After 3 years of treatment,the levels ofβ-CTX and TRACP-5b in the group with poor control of blood glucose were significantly higher than those in the group with good control of blood glucose.3.25-hydroxyvitamin D3 and blood calcium,blood phosphorusThe levels of 25-hydroxyvitamin D-3 before treatment in both groups were lower than normal,and there was no significant difference between the two groups（P>0.05）,increased after treatment,especially in the treatment group,after 3 years of treatment,there was no significant difference in 25-hydroxyvitamin d 3 between the group with poor control of blood glucose and the group with good control of blood glucose（P>0.05）The levels of serum calcium and phosphorus in both groups were within normal range before and after treatment.4.Pearson correlation analysis showed that Hb A1c was negatively correlated with bone mineral density（BMD）,positively correlated withβ-CTX and TRACP-5b,and had no significant correlation with25-hydroxyvitamin D-3 after 3-year treatment.5.Long course of T2DM can cause diabetic nephropathy disease（DKD）.Studies[10-13]have shown that the prevalence of osteoporosis increases with the severity of renal disease in patients with DM,and the severity of osteoporosis is positively correlated with the severity of DKD.Therefore,this study also monitored the changes of serum creatinine,one of the indicators of renal function,before and after treatment in the study of patients with serum creatinine in the normal range.6.New fractures:There were no new fractures in the treatment group and 3 new fractures in the control group during the 3-year observation period,among them 2 cases were lumbar fractures,1 case was forearm fracture.CONCLUSIONZoledronate can increase bone mineral density（BMD）,improve bone metabolism and reduce the risk of fracture in the treatment of Type 2 diabetes Mellitus with postmenopal osteoporosis,the effect of the group with good control of blood glucose was better than that of the group with poor control of blood glucose... |
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