| Objective:To compare the difference of serum ferritin(SF)with different bone mineral density levels in middle-aged and elderly men with type 2 diabetes mellitus(T2DM),and to analyze the correlation between serum ferritin(SF)and osteoporosis(OP).Methods:A total of 150 male patients with type 2 diabetes admitted to the Department of Endocrinology of our hospital from December 2019 to December 2020 were selected,with an age of > 50 years old.According to the exclusion criteria,133 patients were included in the study.According to the 1994 WHO diagnostic criteria for osteoporosis,they were divided into three groups: group A(normal bone mass group,45 cases),group B(osteopenia group,55 cases),and group C(osteoporosis group,33 cases).Record their age,BMI,diabetes duration,past medical history,history of alcohol,tobacco,etc.All patients fasted for 8 hours after 10 o’clock in the evening,venous blood between extraction cubits,on the morning of day 2 after the blood specimen collection immediately sent to the hospital clinical laboratory,laboratory testing alanine aminotransferase(ALT),aspartate aminotransferase(AST)and serum creatinine(Scr),urea nitrogen(BUN),uric acid(UA),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),and low density lipoprotein cholesterol(LDL-C),homocysteine(Hcy),calcium(Ca),phosphorus(P),Magnesium(Mg),alkaline phosphatase(ALP),parathyroid hormone(PTH),fasting plasma glucose(FPG),fasting insulin(FINS),fasting C-peptide(FC-P),glycosylated hemoglobin A1c(Hb Alc),25-hydroxyvitamin D3(25(OH)D3),type I procollagen N-terminal proeptide(PINP),Osteocalcin(OC),β-caroxyl terminal peptide(β-CTX),etc.BMD of the lumbar spine(L1-4)and left hip(Neck,Troch,Ward’s trigonometry)were measured by dual-energy X-ray absorption measurement.Double antibody sandwich method(ELISA)was used to measure the level of SF in ng/m L.SPSS26.0 software was used for data processing,and the results were analyzed.Results:A total of 133 subjects were included,including group A(normal bone mass group,45 cases),accounting for 33.8%;Group B(osteopenia group,55 cases),accounting for41.4%;Group C(osteoporosis group,33 cases),accounting for 24.8%.1.There were statistically significant differences in age,BMI and duration of diabetes among group A,B and C(P < 0.05).Age and duration of diabetes in group C were higher than those in group A and B;BMI was lower than group A and B.2.Comparison of indicators among the three groups:2.1 Blood biochemical indicators: Hcy and TC in group C were higher than those in group A,and the difference was statistically significant(P < 0.05).PTH in group C was lower than that in group A,and the difference was statistically significant(P < 0.05).There was no significant difference in ALT,AST,Scr,BUN,TG,HDL-C,LDL-C,UA,ALP,Ca,P and Mg among other groups(P > 0.05).2.2 Gly metabolism indexes: There were no statistically significant differences in FPG,fasting C-peptide,FINS and HBALC among groups A,B and C(P > 0.05).2.3 Bone metabolism indexes: the level of 25(OH)D3 in group A was higher than that in group B and C,and the difference was statistically significant(P < 0.05).β-CTX in group C was higher than that in group A and B,OC and PINP in group C were lower than those in the other two groups,the difference was statistically significant(P < 0.05).2.4 Comparison of BMD: BMD of lumbar vertebrae(L1-4),Neck,Troch and Ward’s trigonum were statistically significant among A,B and C groups(P < 0.05).2.5 Comparison of serum ferritin levels: With the decrease of bone mass,SF level was gradually increased among groups A,B and C,and the difference was statistically significant(P < 0.05).3.Correlation analysis between ferritin and bone metabolism indexes and bone mineral density:SF was negatively correlated with BMD of 25(OH)D3,OC,PINP,lumbar spine(L1-4),Neck,Troch and Ward’s trigonometry(P < 0.05),but there was no significant correlation with β-CTX(P > 0.05).4.Correlation analysis of bone mineral density in different parts and various indexes:Lumbar(L1-L4)BMD was positively correlated with BMI,25(OH)D3,OC and PINP(P <0.05),and negatively correlated with the course of diabetes,Hcy and β-CTX(P <0.05).BMD in Neck,Troch and Ward’s trigonometry was positively correlated with BMI,25(OH)D3,OC and PINP(P < 0.05),and negatively correlated with age,course of diabetes,Hcy and β-CTX(P < 0.05).5.Using lumbar bone mineral density(L1-4),Neck,Troch and Ward’s triangle as dependent variables,multiple linear regression analysis was used to adjust for confounding factors such as age,BMI,duration of diabetes and Hcy.The results showed that SF was a risk factor for bone mass loss in lumbar spine(L1-4)and Neck,Troch and Ward’s triangle.6.The test variable was serum ferritin value,and the status variable was whether middle-aged and elderly male T2 DM patients had OP(yes =1,no =0).The area under the ROC curve was calculated to be 0.794,P < 0.05.The optimal threshold for SF to predict OP was 70.66 ng/m L,the sensitivity was 1.000,and the specificity was 0.612.Conclusion:1.Serum ferritin levels in middle-aged and elderly men with type 2 diabetes mellitus increased gradually with the decrease of bone mass.2.Serum ferritin was negatively correlated with bone mineral density in middle-aged and elderly men with type 2 diabetes mellitus and osteoporosis,and was a risk factor for bone loss in this population.3.The optimal threshold of serum ferritin for predicting the occurrence of osteoporosis in middle-aged and elderly male patients with type 2 diabetes mellitus is70.66 ng/m L.Monitoring serum ferritin level can provide a new idea for the prevention and treatment of osteoporosis. |
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