The Correlation Between TSH Level And Bone Metabolism Of Postmenopausal Diabetic Patients With Normal Thyroid Function

Objective:To investigate the correlation between TSH levels and BMD and bone metabolism in postmenopausal women with type 2 diabetes(T2DM).Methods:A total of 308 patients with normal thyroid function,type 2 diabetic postmenopausal women were selected from the endocrinology department of the affiliated hospital of Qingdao university from March 2015 to June 2017.Clinical biochemical indexes,bone mineral density and bone metabolism were measured.According to the horizontal stratification of TSH value,it was divided into the low-value TSH group(0.27-1.6m U/L),the median TSH group(1.6-2.9 m U/L),and the high-value TSH group(2.9-4.2 m U/L),namely,A,B and C.There were 109 cases in group A,81 in group B and 118 in group C.The clinical data,biochemical indexes,bone metabolism indexes and bone mineral density of the three groups were collected,and the differences among the general conditions,clinical biochemistry,bone metabolism index and bone density were compared between the groups.Results:(1)The clinical data of the three groups were compared,among which BMI was statistically significant.Compared with group C,group A and group B had A lower BMI(P<0.05).The fasting blood glucose of group B was higher than that of group C(P=0.038).(2)Comparison of biochemical data between the three groups showed statistical significance between the three groups of vitamin D and blood phosphorus(P=0.011.P=0.008).The levels of vitamin D in group C were higher than that in group A and group B(P=0.005,P=0.012).The blood phosphorus level in group C was significantly higher than that in group A and group B(P=0.018,P=0.004).There were statistically significant differences in TSH levels between the three groups,with A higher TSH level(P<0.001)than group A and group B.(3)The BMD in the three groups was statistically significant compared with the lumbar vertebrae(L1-L4),femoral neck,femoral shaft and the Wards triangle.The lumbar BMD of group C was significantly higher than that of group A(P = 0.002).Group C had higher femoral neck BMD(P = 0.008)than group A;Compared with group B and C,group A had lower femoral bone density(P= 0.009,P=0.041).In the Wards triangle area of group A,BMD was lower than group B and group C(P= 0.046,P=0.003);All the femoral BMD was significantly lower in group A than group B and group C,but not statistically significant.Big rotor BMD between the three groups was not statistically significant.,but BMD in group C was higher than group A(P=0.023).(4)There was a positive correlation between TSH and lumbar vertebrae,femoral neck,large trochanter,and Wards triangular area.(r=0.245,0.171,0.132,0.198,P < 0.05).The positive correlation between FT3 and Wards triangle,large rotor and femoral shaft(r=0.132,0.125,0.151;P<0.05).(5)Adjustment for age,menopausal age,BMI,alkaline phosphatase,blood phosphorus influence factors,such as TSH and lumbar(L1-L4)there are positive correlation(r=0.204,P<0.01).TSH was positively correlated with femoral neck bone density(r=0.129,P=0.024)after adjusting the age,duration of menopause,BMI,and blood phosphorus.Adjustment for age,menopausal age,duration of DM,BMI,parathyroid hormone,vitamin D,and alkaline phosphatase,blood phosphorus,TSH and Wards triangle BMD exists positive correlation(r = 0.162,P = 0.162).(6)In the multivariate linear regression analysis,TSH,age,BMI,alkaline phosphatase and lumbar vertebrae(L1-L4)BMD were independently correlated.TSH,age and BMI were independently associated with BMD in the femoral neck.TSH,age,BMI,vitamin D,alkaline phosphatase were independently associated with BMD in the Wards triangle area.Age,BMI,vitamin D,ALP were independently associated with BMD,while TSH,FT3 and BMD had no independent correlation.Conclusions:(1)In postmenopausal T2 DM patients with normal thyroidism,higher TSH levels were higher in bone density,and high TSH had bone protective effect.(2)TSH is independent of thyroid hormone and affects bone metabolism.(3)in the clinical work in T2 DM patients with postmenopausal women with normal,we should be alert to the level of TSH values,for the early focus on TSH values and to reduce the occurrence of osteoporosis patients with provides the clinical basis.