Correlation Analysis Of Insulin Resistance And Fracture Risk In Patients With Type 2 Diabetes Mellitus

Objective:Previous studies have shown that patients with type 2 diabetes mellitus（T2DM）have a higher risk of fracture,and insulin resistance IR may be one of the factors contributing to the increased risk of fracture in patients with T2DM,so fracture events,bone mineral density and type I procollagen aminoterminal peptide（P1NP）were studied in T2DM patients with different levels of insulin resistance The trend of bone metabolism indexes such as proeptide,type I collagen carboxyl terminal peptideβspecial sequence（β-CTX）was analyzed,and the correlation between insulin resistance level and fracture risk and bone mineral density was analyzed,which provided a theoretical basis for the early diagnosis and fracture prevention of Osteoporosis（OP）in patients with T2DM.Methods:After strict screening of inpatients with T2DM who visited the Department of Endocrinology of the First Hospital of Shanxi Medical University from September 2021to December 2022,82 patients with Homeostasis model assessment of insulin resistance（HOMA-IR）≤2.69 and 79 patients with HOMA-IR>2.69 were finally selected for clinical study.General patient data were collected,including previous fracture history and Fracture risk assessment tool（FRAX）scores,and fasting blood glucose（FBG）,fasting insulin（FINS）,glycosylated hemoglobin（Hb A1c）,Ca²⁺,P^3-,Parathyroid hormone（PTH）,osteocalcin（OC）,Type I procollagen N-terminal proeptide（P1NP）Type I collagen carboxyl terminal peptideβspecial sequence（β-CTX）,25hydroxyvitamin D（25（OH）D）,etc.The bone density of the femoral neck was measured and the HOMA-IR and FRAX scores were calculated.（1）According to HOMA-IR levels,patients with T2DM were divided into 2 groups,（1）low insulin resistance group（HOMA-IR≤2.69）,（2）high insulin resistance group（HOMA-IR>2.69）,and gender,age,height,weight,body mass index BMI,diabetes history,Hb A1c,fracture history,and10-year major site fracture probability between the two groups were compared whether the difference between major osteoporotic fracture（PMOF）and the ten year probability of hip fracture（PHF）,bone density,T-value,Z value,Ca²⁺,P^3-,PTH,OC,P1NP,β-CTX,25（OH）VD is statistically significant;（2）Correlation analysis was performed to determine the correlation between fracture history,PMOF,PHF,bone density,T value,Z value,Ca²⁺,P^3-,PTH,OC,P1NP,β-CTX,25（OH）VD and insulin resistance index;Results:1.The difference between fracture history,PHF,PMOF,bone density,T value,Z value,Ca²⁺,OC,P1NP,and 25（OH）VD between the two groups was statistically significant（P<0.05）,among which for fracture history,PHF,PMOF were smaller than the low insulin resistance group,bone density,T value,Z value,Ca²⁺,OC,P1NP,25（OH）VD,and the low insulin resistance group was greater than that of the high insulin resistance group;2.HOMA-IR was positively correlated with fractures,PMOF and PHF,and negatively correlated with bone density,T-value,Z value,Ca²⁺,OC,P1NP,andβ-CTX,and the analysis results were statistically significant（P<0.05）;Conclusion:1.1.In patients with T2DM,with the increase of HOMA-IR,the probability of fracture events,PMOF and PHF tended to increase,and the two were positively correlated..2.In patients with T2DM,bone density and bone formation markers OC,P1NP and25（OH）VD in patients with high insulin resistance are smaller than those in patients with low insulin resistance and are negatively correlated with HOMA-IR,and bone resorption markersβ-CTX are negatively correlated with HOMA-IR.