| Objective:To explore the correlation between obesity levels and bone mineral density and VDR in male patients with type 2 diabetes,and provide valuable information for prevention and early diagnosis for osteopenia and osteoporosis in patients with obesity and diabetes in primary care hospital.Methods:One hundred and seventy-four cases of male patients diagnosed with type 2 diabetes mellitus and obesity were enrolled from May 2014 to April 2016。According to the BMI value,these subjects were divided into the three groups:grade Ⅰ obesity group,grade Ⅱ obesity group and grade Ⅲ obesity group.The bone mineral density and VDR,and the related indexes were measured and analyzed among these three groups.All patients were diagnosed according to the WHO criteria for diabetes 1999,with fasting blood glucose≥ 7.0mmol/L.The BMI was equal or more than 28 at the study.The dual energy X-ray bone sonometers(American GE company)was used to detect the bone mineral density(BMD)of lumbar spine L2-L4,femoral neck,Ward triangle regions and greater trochanter among 3 groups,and the hemoglobin(HbAlc)was measured by the DCA2000+ glycosylated hemoglobin determinator and the matching reagent which were produced by Bayer Corporation in Germany.And the fasting blood glucose(FBG),fasting C-peptide and 25-hydroxyvitamin D3(25-(OH)D3)were determined by Roche 411 electrochemiluminescence method.The radioimmunoassay was used to determine the fasting insulin(FIns),postprandial 2h insul:in(PIns)and alkaline phosphatase(AKP),and the enzyme amplified chemiluminescence immunoassay was used to assess the urinary deoxypyridinoline(Dpd),and the kit was provided by American Dpd company,and the enzyme-linked immunosorbent assay(ELISA)was used to measure the expression levels of serum creatinine(Cr),Ca,P,and vitamin D receptor(VDR).The differences of the above indexes were compared among the grade Ⅰ obesity,grade Ⅱ obesity and grade Ⅲ obesity groups.And the Dpd/Cr and Ca/Cr were calculated.The routine biochemical indicators,bone metabolic markers,VDR,and bone mineral density were compared and analyzed by using variance of repeated measurement data,and the levels of 25-(OH)D3 and VDR of patients with different bone mass were also compared by variance of repeated measurement data.An independent sample t-test was used for the comparison between any two groups,and the Uc test was used to compare the bone mass distribution among diabetic patients with different levels of obesity.The correlation between the obese level and bone mineral density and related indicators in type 2 diabetic patients was analyzed by Pearson correlation analysis.Results:The BMDs of lumbar spine L2-L4,femoral neck,Ward triangle regions and greater trochanter in the grade Ⅲ obesity group were significantly higher than those in the grade Ⅱ obesity group while the BMDs in the grade Ⅱ obesity group were significantly higher than those in the grade Ⅰ obesity group(P<0.05).The levels of 25-(OH)D3 and VDR in the grade Ⅲ obesity group were significantly higher than those in the grade Ⅱobesity group while the levels in the grade Ⅱ obesity group were significantly higher than those in the grade Ⅰ obesity group(P<0.05).The levels of FCP,PCP,Fins and PIns in the grade Ⅲ obesity group were significantly higher than those in the grade Ⅱ obesity group while the levels in the grade Ⅱ obesity group were significantly higher than those in the grade Ⅰ obesity group(P<0.05),but there was no statistically significance in the HbAlc and FBG levels(P>0.05).The levels of 25-(OH)D3 and VDR in normal bone mass group,osteopenia group and osteoporosis group showed a decreasing trend,and there were significant differences between the any two among the three groups(P<0.05).The Pearson correlation analysis showed that obesity levels were positively correlated with BMD,25-(OH)D3 and VDR(r=0.612,0.738,0.546,all P<0.05),and BMD was also positively correlated with 25-(OH)D3 and VDR(r=0.751 and 0.635,P<0.05).Conclusion:There is a relationship between obesity levels,bone mineral density(BMD),and VDR in male patients with type 2 diabetes.And the calculation of obesity levels and the evaluation of VDR of diabetic patients can help to determine the trend of bone mass changes,provide reference for prevention and early diagnosis of osteopenia and osteoporosis in patients with obesity and diabetes in basic hospital. |
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