Influencing Factors Analysis Of Type 2 Diabetic Patients With Osteoporosis

Background:At present,the relationship between type 2 diabetes mellitus?T2DM?and osteoporosis?OP?and fracture is increasingly appreciated.More and more studies have confirmed that there is a close relationship between the both sides,and many factors affect the occurrence and development of diabetic osteoporosis?DOP?.Object:To explore the influencing factors of T2DM patients with OP and analyze their correlation with bone mineral density?BMD?,and provide clinical basis for preventing and controlling the occurrence and development of DOP.Method:The general clinical date of 422 cases of clinically diagnosed T2DM?men are over 50 years old,women are all postmenopausal?were recorded,for instance the gender,age,famale menopause duration,diabetes duration,smoking history,drinking history,etc.Measure height and weight,calculate the body mass index?BMI?of all patients.Laboratory examinations such as serum calcium,serum phosphorus,serum uric acid,total cholesterol?TC?,triglycerides?TG?,low density lipoprotein cholesterol?LDL-C?,high density lipoprotein cholesterol?HDL-C?,fasting blood glucose?FBG?,postprandial blood glucose?PPG?,hemoglobin A1c?HbA1c?in all patients were measured.A total of 333 patients tested fasting C-peptide?FCP?,2hours postprandial C-peptide?2hPCP?,and calculate the homeostasis assessment 2islet?-cell function?HOMA2-%B?,homeostasis assessment 2 insulin sensitivity index?HOMA2-%IS?,homeostasis assessment 2 insulin resistance index?HOMA2-%IR?with HOMA2 calculator.A total of 350 patients tested the serum levels of thyroid stimulating hormone?TSH?.A total of 179 male patients and 166female patents tested follicle-stimulating hormone?FSH?,luteinizing hormone?LH?,estradiol?E₂?,testosterone?T?,sex hormone binding globulin?SHBG?,and apply formulas to calculate free testosterone?FT?and free estradiol?FE₂?.A total of 346patients tested 24-hour urine free cortisol?24hUFC?,parathyroid hormone?PTH?,amino-terminal procollagen of type I collagen?PINP?,25-hydroxyvitamin D₃[25-?OH?D₃],N-telopeptide osteocalcin?NMID?,cross linked C-telopeptide?special sequence of type I collagen??CTX?.Dual-energy X-ray absorptiometry was used to measure the BMD of the positive lumbar spine 1 to 4,the left hip and the femoral neck.Patients were divided into 3 groups accroding to the OP diagnostic criteria:group N1?normal bone mass,154 cases?,group N2?decreased bone mass,151 cases?,group N3?osteoporosis,117 cases?.Male and female patients were divided into 3 groups according to BMD levels.Males were divided into group A1?normal bone mass,98 cases?,group A2?decreased bone loss,71 cases?,group A3?osteoporosis,50 cases?,females were divided into group B1?normal bone mass,56 cases?,group B2?decreased bone mass,80 cases?,group B3?osteoporosis,67cases?.And 346 patients were evaluated for the propensity of anxiety and depression.Data were analyzed using SPSS 17.0 statistical software,including single factor analysis of variance,chi-square test,rank sum test,Pearson correlation analysis,Spearman correlation analysis and Logistic regression analysis.P<0.05 was considered statistically significant.Results:?1?The occurrence of OP in patients with T2DM:the patients with normal bone mass,bone mass loss,and OP respectively accounted for 36.49%,35.78%and27.73%of the total quantity of patients enrolled.The incidence of bone mass loss and OP in female patients were significantly higher than male?P<0.01?.?2?There were no statistical differences between HbA1c,serum calcium,serum phosphorus,TC,TG,LDL-C,HDL-C,FCP,2hPCP,lnHOMA2-%IS,lnHOMA2-%IR,TSH,PTH,25-?OH?D₃,smoking history,drinking history in different bone status groups?P>0.05?.The age,female menopause duration,24hUFC,?CTX in group N1were all obviously lower than those in group N3?P<0.05?,and the PINP,NMID,lnHOMA2-%B were obviously higher than those in group N3?P<0.05?,but there were no obviously differences between group N1 and N2,group N2 and N3?P>0.05?.The FBG,PPG and proportion of patients with anxiety and depression in group N1and N2 were obviously lower than those in group N3?P<0.05?,but no statistical differences between group N1 and N2?P>0.05?.The diabetes duration in group N1was obviously lower than that in group N2 and N3?P<0.05?,and the BMI,serum uric acid and various parts of BMD were obviously higher than those in group N2 and N3?P<0.05?,except for the all parts BMD in group N2 were significantly higher than those in group N3?P<0.01?,there were no obviously differences of the other above indicators between group N2 and N3?P>0.05?.?3?According to different genders,patients were divided into 3 groups with different bone mass status.In male patients,there were no statistical differences in LH,E₂ levels among the three groups?P>0.05?.The FSH level in group A1 and A2was significantly lower than that in group A3?P<0.01?,the T level was significantly higher than that in group A3?P<0.01?,but no statistical differences between group A1and A2?P>0.05?.The FT level in group A1 was obviously higher than that in group A2 and A3?P<0.05?,but no statistical differences between group A2 and A3.The FE₂level in group A1 was obviously higher than that in group A3?P<0.05?,but no statistical differences between group A1 and A2,group A2 and A3?P>0.05?.In female patients,there were no statistical differences in LH,T,FT levels between the three groups?P>0.05?.The FSH level in group B1 was significantly lower than that in group B3?P<0.01?,but there were no statistical differences between group B1 and B2,group B2 and B3?P>0.05?.The E₂,FE₂ level in group B1 were significantly higher than that in group B2 and B3?P<0.01?,but there were no statistical difference between group B2 and B3?P>0.05?.?4?Correlation analysis showed that all parts BMD were obviously negatively correlated with age,female menopause duration,diabetes duration,FBG,PPG and24hUFC?P<0.05?,and were obviously positively correlated with blood uric acidthe,lnHOMA2-%B,PINP,the FT of male patients and the FE₂ of female patients?P<0.05?,but no correlations with smoking history and drinking history?P>0.05?.The BMD in lumbar spine was obviously positively correlated with BMI,the T,FE₂of male patients?P<0.05?,and obviously negatively correlated with the FSH of male and female patients,the tendency of anxiety and depression?P<0.05?.The hip BMD was obviously positively correlated with BMI,NMID and the FE₂ of male patients?P<0.05?.The BMD in femoral neck was obviously negatively correlated with?CTX,the FSH of female patients,the tendency of anxiety and depression?P<0.05?,and obviously positively correlated with the T of male patients?P<0.05?.?5?Correlation analysis showed that bone formation markers PINP,NMID and bone resorption marker?CTX were not obviously correlated with FBG,PPG,24hUFC and TSH?P>0.05?.?6?Logistic regression analysis showed that gender,age,female menopause duration,diabetes duration,PPG,24hUFC,the FSH of male and female patients,the tendency of anxiety and depression were risk factors of OP in patients with T2DM,while BMI,serum uric acid,lnHOMA2-%B,the T?FT and FE₂ of male patients,the E₂ and FE₂ of female patients were the protective factors that inhibit the occurrence of OP.Conclusion:Among T2DM patients,older age,menopausal women,longer menopause duration,longer diabetes duration,lower body weight,higher postprandial blood glucose,lower serum uric acid level within normal range,poor islet?-cell function,lower androgen and estrogen level,higher cortisol level,the tendency of anxiety and depression were all risk factors of OP.