| Part I: Risk factors for bone mass abnormalities and 10-year probability of fracture risk in type 2 diabetes mellitusObjectiveTo explore the risk factors of bone mass abnormalities and the 10-year probability of fractures assessed by fracture risk assessment tool(FRAX)in patients with type 2 diabetes mellitus(T2DM).MethodsA total of 165 patients diagnosed with T2 DM were enrolled from October 2021 to December 2022 in the Department of Endocrinology,the Third Affiliated Hospital of Guangzhou Medical University based on inclusion and exclusion criteria.General data and clinical indicators of enrolled patients were collected.Bone mineral densities of lumbar spine 1-4(L1-L4),femoral neck(FN)or total hip(TH)were measured by dual-energy X-ray absorptiometry(DXA).The study population was divided into normal bone mineral density group(n = 68)and abnormal bone mass mineral group(including osteopenia and osteoporosis,n = 97)according to T-value.The 10-year probability of major osteoporotic fracture(MOF)and hip fracture(HF)was assessed by the FRAX.Rheumatoid arthritis(RA),one of the fracture risk factors listed in the FRAX algorithm,was input into FRAX to calculate the 10-year probability of HF and MOF in patients with T2 DM.Results1.A total of 165 patients with T2 DM were included in this study,and the incidence of abnormal bone mass was 58.79%.Compared with the normal bone mineral density group,patients with the abnormal bone mineral density were older,more likely to be female,and had higher levels of FRAX MOF,FRAX HF,FRAX MOF(RA),FRAX HF(RA),β-CTX,T-PINP,OC,LH,and FSH(all P < 0.05).Moreover,they had lower prevalence of Metabolic-associated fatty liver disease(MAFLD)and lower levels of BMI,T,E2 and IGF-1(all P < 0.05).2.In the correlation analysis,BMI,HOMA-IR(CP),T,E2,IGF-1 were positively correlated with L1-L4 BMD,FN BMD and TH BMD(all P < 0.05).25(OH)D was positively correlated with FN BMD and TH BMD(both P < 0.05).Age,β-CTX,T-PINP and OC was negatively correlated with L1-L4 BMD,FN BMD,TH BMD(all P < 0.05).LH and FSH were negatively correlated with L1-L4 BMD,FN BMD and TH BMD(all P < 0.05).In addition,β-CTX was positively correlated with FRAX MOF(RA)(P < 0.05).Both LH and FSH were positively correlated with the10-year fracture risk predicted by modified FRAX(all P < 0.05).T-PINP was positively correlated with MOF and HF predicted by modified FRAX(all P < 0.05).In contrast to T-PINP,IGF-1 was negatively correlated with these indices(both P <0.05).E2 was negatively correlated with the 10-year probability of fracture risk as predicted by modified FRAX scores(all P < 0.05).T was negatively correlated with FRAX MOF(RA)(P < 0.05).However,there was no significant associations between diabetes duration,Glycated hemoglobin A1c(Hb A1c),PTH,CT with BMD and 10-year probability of fracture risk(all P < 0.05).3.In the multivariable linear regression model,MAFLD and HOMA-IR(CP)were still positively corelated with L1-L4 BMD(MAFLD: β = 0.077,P = 0.023;HOMA-IR(CP): β = 0.041,P = 0.020).In addition,MAFLD and HOMA-IR(CP)were also positively corelated with TH BMD(MAFLD: β = 0.046,P = 0.042;HOMA-IR(CP): β =0.031,P = 0.005).We did not find an independent association between sex hormone markers and BMD or the 10-year probability of MOF and HF.Among bone turnover indexes,β-CTX,T-PINP and OC were negatively corelated with L1-L4 BMD,FN BMD and TH BMD,while 25(OH)D was positively corelated with FN BMD and TH BMD.Only IGF-1 was found to be negatively corelated with FRAX MOF(RA)(β =-0.013,P = 0.036).ConclusionThe risk factors for abnormal bone mass in patients with T2 DM include age,gender(female)and other recognized risk factors.This study also found that MAFLD and HOMA-IR(CP)were significantly positively correlated with L1-L4 BMD and TH BMD.Besides,β-CTX,T-PINP and OC were negatively correlated with BMD at these three sites.In addition,the association between IGF-1 and the 10-year probability of MOD in patients with T2 DM was significantly negative.Part II: The association between serum Galanin level with BMD and 10-year probability of fracture risk in patients with T2DMObjectiveTo explore the associations between serum Galanin levels with BMD and 10-year probability of fracture risk in patients with T2 DM.MethodsA total of 85 patients(46 males and 39 females)with T2 DM were enrolled from June 2022 to December 2022 in the Department of Endocrinology,the Third Affiliated Hospital of Guangzhou Medical University based on inclusion and exclusion criteria.General data and clinical indicators of enrolled patients were collected.Serum Galanin levels were detected by enzyme-linked immunosorbent assay(ELISA).According to the median of serum Galanin levels,the study population was divided into low serum Galanin group(n = 42)and high serum Galanin group(n = 43).The 10-year probability of major osteoporotic fracture(MOF)and hip fracture(HF)was assessed by the FRAX.Rheumatoid arthritis(RA),one of the fracture risk factors listed in the FRAX algorithm,was input into FRAX to calculate the 10-year probability of HF and MOF in patients with T2 DM.The BMD was measured by DXA.Results1.Compared with the low serum Galanin group,the patients with high serum Galanin had higher levels of β-CTX,remnant cholesterol(remnant-c),FRAX HF and FRAX HF(RA),and the difference were statistically significant(P < 0.05).There were no significant differences in sex,age,body mass index(BMI),diabetes duration,levels of Glycated hemoglobin(Hb A1c),and BMD between the two groups(both P >0.05).2.The correlation analysis indicated that serum Galanin level was positively correlated with BMI and remnant-c(BMI: r = 0.225,P = 0.030;Remnant-c: r = 0.224,P = 0.046).Serum Galanin level was positively correlated with β-CTX and T-PINP(β-CTX: r = 0.244,P = 0.024;T-PINP: r = 0.218,P = 0.045).In addition,there was a positive correlation between serum Galanin level and FRAX HF(RA)(r = 0.312,P =0.007).In addition,serum Galanin level was negatively correlated with HDL-c(HDLc: r =-0.231,p = 0.039).However,there was no correlation between serum Galanin level and PTH,CT,OC,25(OH)D and IGF-1(all P < 0.05).There was no correlation between Galanin level and glucose metabolism index,HOMA-IR(CP),HOMA-β(CP)(all P > 0.05).3.In the multivariate linear regression analysis,serum Galanin level was negatively correlated with TH BMD(β =-0.006,P = 0.006),but not with L1-L4 BMD and FN BMD(L1-L4 BMD: β =-0.007,P = 0.054;FN BMD: β =-0.003,P =0.077).In addition,serum Galanin level was significantly positively correlated with FRAX HF(RA)(β = 0.087,P = 0.020).ConclusionIn patients with T2 DM,the level of serum Galanin was significantly positively correlated with bone formation marker T-PINP and bone resorption marker β-CTX.The levels of serum Galanin were independently positively associated with TH BMD and 10-year probability of HF in patients with T2 DM. |
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