| Objectives: Diabetic osteoporosis (DOP) refers to a kind of systemic metabolicosteopathy in patients with type2diabetes mellitus (T2DM) which can lead to increasedskeletal fragility because of bone mass reducing and microarchitectural deterioration,resulting in high risk of fracture. It is considered as one of the chronic complications fordiabetes mellitus (DM), whose pathogenesis has not been fully clarified. Current studiesshowed that DOP was mainly associated with several factors including high bloodglucose levels, insulin levels alternation, concentration of advanced glycationend-products (AGEs), decrease of insulin-like growth factor1(IGF-1) and other chroniccomplications of DM. Via observing the difference of bone mineral density (BMD) andbone metabolic markers among T2DM patients treated with insulin aspart, T2DMpatients treated with oral hypoglycemic agents alone and nondiabetic controls, thepresent study discussed the relationship between T2DM and osteoporosis (OP) andanalyzed the influencing factors on BMD as well as bone metabolic markers in T2DMpatients. The purpose of our study was to explore the impact of insulin aspart treatmenton BMD and bone metabolic markers in T2DM patients, providing clinical evidence forthe prevention and treatment of DOP.Methods: The present study selected55cases of T2DM patients hospitalizing inthree department Endocrinology of the First Hospital Affiliated to Dalian MedicalUniversity from March2012to January2013. Based on the World Health Organizationdefinition of diabetes (1999) and classification criterions, all patients were definitivelydiagnosed as T2DM for over1year, Male aged30-60years old, Female32years old-pre-menopausal, glycosylated hemoglobin A1c5.6-12.0%. Thirty cases (21male and9female) were divided into the insulin aspart30treatment group (Group C), receiving thecombined treatment of insulin aspart30injection and taking hypoglycemic agents(biguanides and alpha glucosidase inhibitors) for at least1year. The other25cases (17 male and8female) were divided into oral hypoglycemic agents treatment group (GroupB), orally administrating sulfonylureas, biguanides or alpha glucosidase inhibitors for atleast1year. Thiazolidinediones was not applied in all these T2DM patients. Another30healthy persons (20male and10female) having health check-up in our hospital werecollected as normal control group. For hospitalized patients, height, weight, systolicblood pressure (SBP) and diastolic blood pressure (DBP) were measured on the first dayand then body mass index (BMI) was calculated. Meanwhile blood samples were testedfor all of the followings on the second morning: fasting plasma glucose (FPG), aspartateaminotransferase (AST), alanine aminatransferase (ALT), total cholesterol (TC),creatinine（CRE）, uricacid (UA）, glycosylated hemoglobin A1c (HbA1c), fasting Cpeptide (FCP) and post oral glucose2hour C peptide (2hCP), serum calcium, serumphosphate, alkaline phosphatase (ALP), calcitonin (CT) and parathyroid hormone(PTH). Dual energy X-ray absorptiometry (DXA) from HOLOGIC Discovery A wasapplied for measuring the BMD of Group A (30case), Group B (20case) and Group C(30case). Skeletal sites of measurement were made over the Neck and Troch in thenon-dominant proximal femur and lumbar spine (L1-L4). The general data, bonemetabolic markers and BMD were compared between DM patients and normal controls,also between Group B and Group C. Pearson’s bi-variables correlation was used toanalyze the association between BMD and general data and bone metabolic markers inGroup B and Group C. BMD as dependent variable, general data, bone metabolicmarkers, exercise level, smoking status and alcohol intake as independent variables,logistic regression was used to examine the relevant factors contributing to BMD.Results:(1) Neither of DM groups was significantly different from control groupin gender, age, TC, AST, ALT, ALP, serum UA and Cre (P>0.05). T2DM patients hadnotably higher FPG (P=0.000), BMI (P=0.013)and P (P=0.023), but much lower serumCa and PTH(P=0.000, P=0.000), than normal controls. In addition, T2DM patients hadlower BMD at lumbar spine1-4than normal controls (P=0.009for L1, P=0.004for L2,P=0.004for L3, P=0.001for L4, respectively).(2) There were no significant difference in gender, course, age, SBP, DBP, BMI,ALP, HbA1c, TC, ALT, AST, serum UA, FPG and serum Cre between Group B andGroup C (P>0.05). Patients in Group C had higher ALP (P=0.015) but lower FCP(P=0.001) and2hCP (P=0.013) than Group B. Group C showed higher BMD at L2-4than Group B (P=0.017for L2, P=0.020for L3and P=0.012for L4, respectively). (3) In Group B, the measuring data demonstrated that TC had a negativecorrelation with BMD at L1(r=-0.489，P=0.013), L2(r=-0.462，P=0.020), L3(r=-0.460，P=0.021) and L4(r=-0.456，P=0.022). Also, ALP was negatively associatedwith BMD at L2(r=-0.418，P=0.038), L3(r=-0.453，P=0.023) and L4(r=-0.508，P=0.010). There were no correlation between other general data and bone metabolicmarkers.(4) In Group C, BMI was positively correlated with BMD at Neck (r=0.441，P=0.015) and UA was also positively correlated with BMD at Neck (r=0.375，P=0.041).However, TC was negatively correlated with BMD at L4(r=-0.433，P=0.017), Neck(r=-0.387，P=0.034) and Torch (r=-0.563，P=0.001). FPG was negatively correlatedwith Torch (r=-0.405，P=0.027). There were no correlation between other general dataand bone metabolic markers.(5) Analysis of measuring data showed that smoking status had no correlation withBMD of T2DM patients. Low levels of alcohol intake and moderate exercise hadpositive correlation with BMD levels of T2DM patients(P=0.000, P=0.022).Conclusions:1. Patients with T2DM had different levels of BMD decrease at lumbar spine,compared with healthy people.2. The application of insulin aspart30may have better efficacy than taking oralhypoglycemic drugs in elevating BMD of T2DM patients.3. BMD levels of T2DM patients probably decrease along with the increase ofblood glucose and serum lipid level but increase with the elevation of BMI.4. Moderate alcohol intake and exercise are likely to increase BMD levels ofT2DM patients. |
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