Relationships Between Bone Turnover Markers,bone Mineral Density And Glycolipid Metabolism In Type 2 Diabetic Patients

Objectives:Bone mineral density(BMD)in type 2 diabetic patients(T2DM)often increased or normal,but the risk of fracture increased,suggesting dual energy X-ray absorptiometry(DEXA)detected BMD that can not fully respond to bone health status of diabetic patients.This study aimed at investigating the relationships between bone turnover markers(BTMs),BMD and Glycolipid metabolism in patients withT2DM,and to explore the early diagnostic value of BTMs in patients with T2DM and osteoporosis(OP).Methods:A total of 121 patients(71 males,mean age 59.28±9.53;50 females,mean age 65.02±10.33)with T2DM were selected from Department of Endocrinology,the First Affiliated Hospital of Nanjing Medical University,from March 2016 to March 2017.All subjects were fasted 10-12 hours,then they were tested with fasting plasma glucose(FPG),calcium(Ca),phosphorus(P),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL),low density lipoprotein cholesterol(LDL),alkaline phosphatase(ALP),uric acid(UA),Urine microalbumin(uMA),glycosylated hemoglobin(HbAIC),25 hydroxy vitamin D[25(OH)D],parathyroid hormone(PTH),type 1 procollagen N-peptide(PINP),β-crosslinked-type 1 collagen C-terminal peptide(CTX).They received 75g oral glucose tolerance test(OGTT),insulin and C peptide release test and they were measured BMD at lumbar vertebrae(L1,L2,L3,L4,total)and hip(femoral neck,large rotor,femur trochanter,Ward’s triangle,total)by DEXA scan.In addition,all subjects were recorded of the gender,age,height,weight,duration,drug history,menstrual history and medical history in detail;The body mass index(BMI),insulin resistance index(HOMA-CR),insulin secretion index(HOMA-β)and C-peptide area under chive(CAUC)were calculated according to formula.The collected all data were analyzed by SPSS 24 statistical software.The variables of the continuity normal distribution are expressed by the mean ± standard deviation(X±S),and the non-normal distribution data is logarithmically transformed.Comparison between groups using independent sample t test or single factor analysis of variance;The correlation between the two variables was analyzed using Pearson correlation or partial correlation.Multivariate analysis using multiple linear regression,P<0.05 for the difference was statistically significant.Result:1.In male T2DM patients,conpared OP group with non-OP group,the differences of TG,PINP and p-CTX were statistically significant;but there were no obvious differences of the levels of ALP,PTH,25(OH)D between the two groups.2.In postinenopausal women with T2DM,compared OP group with non-OP group,the differences of Age and PTH were statistically significant;but there were no obvious differences of the levels of ALP、PINP、β-CTX、25(OH)D between the two groups.3.Comparison of different levels of HbA1c in T2DM patients,there were significant differences in ALP,lguMA.PTH.25(OH)D;but there were no obvious differences in P1NP and β-CTX.4.In male T2DM patients,there was a positive correlation between PTH and BMI,CAUC,negatively correlated with HbA1c;P1NP was negatively correlated with FPG,Ca,TG,UA and lguMA.β-CTX was positively correlated with BMI and HbAlc,and negatively correlated with Ca and UA.5.In postmenopausal women with T2DM,ALP was positively correlated with Ca;PTH was positively correlated with BMI,FCP and HOMA-CR;P1NP was positively correlated with FPG;25(OH)D was negatively correlated with FPG,FCP and HOMA-CR.6.In male T2DM patients,there was a positive correlation between BMI and lumbar spine BMD,total hip BMD;HbAlc was negatively correlated with lumbar spine BMD;25(OH)D was positively correlated with femoral neck BMD,total hip BMD.7.In postinenopausal xvomen with T2DM,there was a positive correlation between BMI and lumbar spine BMD,femoral neck BMD,total hip BMD.ALP was negatively correlated with femoral neck BMD and total hip BMD;UA was positively correlated with lumbar spine BMD,femoral neck BMDS total hip BMD;there was a negative correlation between P1NP and femoral neck BMD,total hip BMD;β-CTX was negatively correlated with lumbar spine BMD.8.Multivariate regression analysis showed that in male T2DM,HbA1c,CAUC had a great effect on PTH;Ca and LnuMA had a significant impact on P1NP.Ca and UA had a great effect on β-CTX.BMI is the independent influencing factor of lumbar spine BMD;25(OH)D is an independent influencing factor of femoral neck BMD;BMI,25(OH)D had a significant effect on the total hip BMD.In postmenopausal women T2DM,Ca is an independent influencing factor of ALP;HOMA-CR is an independent influencing factor of PTH;FPG is the independent influencing factor of PINP;HOMA-CR is an independent factor of 25(OH)D.BMI and β-CTX had a great effect on the total BMD of lumbar spine;BMI is an independent factor in total hip BMD.Conclusion:1.T2DM patients with OP have some changes in bone metabolism;BTMs and BMD have a certain correlation,combined detection of BTMs and BMD,contribute to diabetic osteoporosis(DOP)screening,early diagnosis and guidance of treatment.2.BTMs and FPG,FCP,HbA1c,Cauc,HOMA-CR are closely related,suggesting that glucose metabolism and bone metabolism affect each other,So control blood sugar,promote insulin secretion,improve insulin resistance,help to protect bone metabolism,prevention and treatment of DOP.3.T2DM patients with appropriate supplement 25(OH)D,help to lower blood sugar,improve insulin resistance,prevention and treatment of DOP and fracture occurred.