| Objective:To investigate the Association of decreased bone mineral density(including osteopenia and osteoporosis)with coexisting carotid and lower limb atherosclerotic plaques in middle-aged and elderly(age?45 years)patients with type 2 diabetes mellitus(T2DM)of different genders.Method:This was a cross-sectional retrospective study.Patients(n=716 cases,including 237 men and 479 women)with type 2 diabetes mellitus,hospitalized in the department of endocrinology,Yantai Yuhuangding hospital affiliated to Qingdao university from January2016 to February 2018,aged over 45 years old(over 1 year after menopause in women),were enrolled in the study.They were divided into male and female group according to gender.Bone mineral density(BMD)at the lumbar spine between L1-L4,the femoral and the hip was measured using dual-X-ray absorptiometry.Patients according to the BMD were divided into normal bone mass group and decreased BMD group(including osteopenia and osteoporosis),Carotid intima media thickness(CIMT)and atherosclerotic plaques as well as lower limb atherosclerotic plaques were examined using B-mode ultrasonography.Patients according to the plaque formation in different positions were divided into carotid artery(plaque group and non-plaque group)and lower limb artery(plaque group and non-plaque group).Finally,according to the multi-site plaque formation,the patients were divided into three groups: non-plaque group(both carotid artery and lower limb artery without plaque group),single-site plaque group(simple carotid artery or simple lower limb artery plaque group),and multi-site plaque group(both carotid artery and lower limb artery with plaque group).statistical analysis of related factors.Result:1.There were statistically significant differences between the decreased BMD group and the normal bone mass group in age,BMI,alkaline phosphatase,average carotid artery plaque thickness and average carotid artery plaque length in the middle-aged and elderly male patients with T2DM(P < 0.05).There were statistically significant differences between the low bone mass group and the normal bone mass group in age,course of disease,BMI,LDL-C,uric acid,alkaline phosphatase,retinol-binding protein,CIMT,average carotid plaque thickness and average carotid plaque length in the middle-aged and elderly Female patients with T2DM(P < 0.05).2.BMD(bilateral femoral and left hip)of middle-aged and elderly male patients with T2 DM was negatively correlated with the average thickness of carotid artery plaque(P <0.05),while BMD(bilateral femoral)was negatively correlated with the average length of carotid artery plaque(P < 0.05).BMD(lumbar at L1-L4,bilateral femoral,bilateral hip)of the middle-aged and elderly female patients with T2 DM was negatively related to the CIMT(P < 0.05),BMD(lumbar at L1-L4,bilateral femoral,bilateral hip)was negatively related to the average thickness of carotid plaques(P < 0.05),BMD(lumbar at L1-L4,bilateral femoral,bilateral hip)was negatively related to the average length of carotid plaques(P < 0.05).3.BMD(bilateral femoral and hip)of the middle-aged and elderly male patients with T2 DM was significantly lower in both carotid artery and lower limb artery plaque group than non-plaque group(P < 0.05).BMD(bilateral femoral and hip)of the middle-aged and elderly female patients with T2 DM was significantly lower in both carotid artery and lower limb artery plaque group than in the non-plaque group(P < 0.05),while BMD(lumbar L1-L4)was significantly lower in lower limb artery plaque group than in the non-plaque group of the middle-aged and elderly female patients with T2DM(P < 0.05).4.The incidence of decreased BMD in both carotid artery and lower limb artery plaque group of the middle-aged and elderly male patients with T2 DM was significantly higher than that in the non-plaque group,with statistically significant difference(carotid artery37.57% vs 16.07%,?2=9.011,P=0.003).Lower limb artery 36.84% vs 21.21%,?2=5.304,P=0.021).The incidence of decreased BMD in both carotid artery and lower limb artery plaque group of the middle-aged and elderly female patients with T2 DM was significantly higher than that in the non-plaque group,and the difference was statistically significant(carotid artery 56.18% vs 46.04%,?2= 4.070,P=0.044).Lower limb artery 59.43% vs44.44%,?2= 10.479,P=0.001).5.The presence of decreased BMD was conducted into binary Logistic regression analysis,under the precondition of the influence factors such as age,course of diseases,respectively,Included the carotid artery plaque formation,lower limb artery plaque formation and different parts of the plaque formation,In the middle-aged and elderly male patients with T2 DM,the results showed that older,high fasting glucose,elevated alkaline phosphatase,carotid artery plaque formation,lower limb artery plaque formation and different parts of the formation is a risk factor for decreased BMD,high BMI are protective factors of decreased BMD;In the middle-aged and elderly female patients with T2 DM,older and elevated alkaline phosphatase are risk factors for decreased BMD,while high BMI and late menopausal age are protective factors for decreased BMD.The prevalence of low bone mass in middle-aged and elderly T2 DM men with multi-site plaque was 5.559 times higher than that in those non-plaque.There was no statistically significant difference in the risk of low bone mass between patients with single-siteplaque and those non-plaque.Conclusion:1.Atherosclerosis was closely related to decreased BMD in the middle-aged and elderly patients with type 2 diabetes mellitus of different genders.2.We found that the coexistence of carotid and lower limb atherosclerosis increased the prevalence of decreased BMD in the middle-aged and elderly patients with type 2diabetes mellitus of different genders3.The independent role of bone metabolism in atherosclerotic changes in women was not supported.Either carotid or lower limb atherosclerosis may be related to decreased BMD in middle-aged and elderly male with type 2 diabetes mellitus;in combination,they may further increase the risk of decreased BMD in this population.Therefore,diabetic macrovascular disease may be a contributing factor to bone loss,which may lead to bone dystrophy by affecting bone blood circulation. |
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