Relationship Between Thyroid Hormone And Bone Mineral Density In Elderly Type 2 Diabetic Patients With Normal Thyroid Function

Objective:To study the clinical data of patients with type 2 diabetes mellitus,to analyze the distribution of diseases of different thyroid function status in patients with type 2 diabetes mellitus,to compare the prevalence of osteoporosis in patients with type2 diabetes mellitus between normal thyroid function group and abnormal thyroid function group,to further explore the relationship between the reference range of thyroid hormone levels and bone mineral density in elderly patients with type 2 diabetes mellitus.Methods:A retrospective study was conducted on 3925 patients with type 2 diabetes who were hospitalized in the Endocrine Diabetes Hospital of Shaanxi Province People's Hospital from January 2017 to May 2018.The patients who met the exclusion criteria were excluded.Firstly,according to the disease status,they were divided into normal thyroid function group?3474 cases?and thyroid dysfunction group?451 cases?.The thyroid dysfunction group was also divided into hyperthyroidism group?including clinical and subclinical hyperthyroidism?and hypothyroidism group?including clinical and subclinical hypothyroidism?.To investigate the distribution of diseases in type 2diabetes mellitus patients with different thyroid function.To analyze the prevalence of osteoporosis in T2DM patients with normal thyroid function.Then 216 elderly patients with type 2 diabetes mellitus with normal thyroid function who met the criteria and had complete case data were screened.According to the three digits of TSH,FT3 and FT4from low to high,the patients were divided into Group A,B and C.The differences of total hip BMD and total lumbar BMD among the three groups were compared.To study the correlation of total hip BMD and lumbar BMD with TSH,FT3,FT4 and other clinical indicators,and to explore the influencing factors of total hip BMD and lumbar BMD.Results:?1?A total of 3925 patients with type 2 diabetes mellitus were included in this study.451 patients had abnormal thyroid function and the prevalence rate was 11.5%.29 patients with hyperthyroidism were included and the prevalence rate was 0.7%.422patients with hypothyroidism were included and the prevalence rate was 10.8%.Wherein clinical hyperthyroidism,subclinical hyperthyroidism,clinical hypothyroidism,subclinical hypothyroidism prevalence rates were 0.4%,0.3%,1.8%,9.0%.Among the patients with abnormal thyroid function,the subclinical hypothyroidism group accounted for the largest proportion.?2?The prevalence of osteoporosis in normal thyroid function group,hyperthyroidism group and hypothyroidism group was compared.There was no significant difference in the distribution of osteoporosis among the three groups?P>0.05?.?3?The patients with normal thyroid function were divided into three age groups according to their age less than or equal to 44 years old,45 years old to 59 years old,and more than or equal to 60 years old.With the increase of age,the prevalence of osteoporosis in patients with normal thyroid function in type 2 diabetes mellitus increased.There was significant difference in the distribution of osteoporosis among the three groups?P<0.05?.?4?The proportion of female patients with type 2 diabetes mellitus with normal thyroid function complicated with osteoporosis was higher than that of male patients,and the difference was statistically significant?P<0.05?.?5?In FT3 three-digit group,BMD of total hip in group A?that is,FT3 normal low value group?was lower than that in group C?that is,FT3 normal high value group??P<0.05?;BMD of total lumbar spine in FT3 three-digit group had no significant difference?P>0.05?.In the three-digit grouping of TSH and FT4,there was no significant difference in total hip BMD and total lumbar BMD among the three groups?P>0.05?.?6?Pearson's correlation analysis showed that total hip BMD was positively correlated with diabetes duration,body mass index,hip circumference and FT3?P<0.05?,negatively correlated with age and alkaline phosphatase?P<0.05?,but not with hypertension duration,pulse,waist circumference,systolic pressure,diastolic pressure,fasting plasma glucose,glycosylated hemoglobin A_1c,serum calcium,serum phosphate,total cholesterol,triglyceride,high density lipoprotein cholesterol,low density lipoprotein cholesterol,TSH,FT4,TGAb and TPOAb?P>0.05?;all lumbar BMD was positively correlated with body mass index,waist circumference and hip circumference?P<0.05?,negatively correlated with serum phosphate?P<0.05?.There was no correlation among age,diabetes duration,pulse,systolic pressure,diastolic pressure,fasting plasma glucose,glycosylated hemoglobin A_1c,serum calcium,total cholesterol,triglyceride,high density lipoprotein cholesterol,low density lipoprotein cholesterol,TSH,FT3,FT4,TGAb and TPOAb?P>0.05?.?7?Multiple linear regression analysis showed that alkaline phosphatase was a risk factor for the reduction of BMD in the total hip?P<0.05?;Body mass index and FT3 were protective factors for the reduction of BMD in the total hip?P<0.05?.Serum phosphate was the risk factor for the reduction of BMD in all lumbar spine?P<0.05?,and body mass index was the protective factor for the reduction of lumbar spine BMD?P<0.05?.Conclusion:?1?The prevalence of thyroid dysfunction in type 2 diabetes mellitus was 11.5%,of which the ratio of subclinical hypothyroidism was the largest.?2?In euthyroid patients with type 2 diabetes,the greater the age,the higher the prevalence of osteoporosis,and women are more likely to merge osteoporosis.?3?In elderly patients with type 2 diabetes mellitus with normal thyroid function,FT3 was positively correlated with total hip BMD and was not associated with all lumbar BMD.FT3 was a protective factor for reduction of total hip BMD.TSH and FT4 were not associated with total hip BMD and all lumbar BMD.