Type 2 diabetic osteoporosis: risk factors and early diagnosis by quantitative CT

doi:10.3877/cma.j.issn.1674-0785.2020.08.006

Abstract

Abstract:

Objective

To identify the risk factors for osteoporosis (OP) associated with type 2 diabetes mellitus (T2DM), and to assess the clinical application values of quantitative CT in the early diagnosis of this condition.

Methods

We selected 220 T2DM patients at Northern Jiangsu People′s Hospital as study subjects. Dual-energy X-ray absorptiometry (DXA) and quantitative CT were used to detect the bone mineral density (BMD) and volume bone mineral density of the lumbar spine, respectively. The patients were divided into either an OP group or a non-OP group according to the BMD of the lumbar spine detected by DXA. Gender, age, duration of disease, BMI, FPG, 2hPG, FCP, 2hCP, HbA1c, CHO, TG, HDL-C, LDL-C, alkaline phosphatase, phosphorus, calcium, parathormone (PTH), CTx, N-MID, TP1NP, vitamin D, and creatinine were compared between the two groups, and correlation and regression analyses were also performed.

Results

The prevalence of OP in women was higher than that in men (46.4% vs 29.3%, χ²=8.319, P=0.012). The average age, duration of disease, HbA1c, PTH, and CTx of the OP group were significantly higher than those of the non-OP group (P<0.05). BMI, N-MID, TP1NP, and vitamin D in the OP group were significantly lower than those in the non-OP group (P<0.05). CTx was negatively associated with 2hPG (r=-0.165, P<0.05). TP1NP was negatively associated with FPG (r=-0.224, P<0.05) and 2hPG (r=-0.191, P<0.05). N-MID was negatively associated with FPG (r=-0.280, P<0.05), 2hPG (r=-0.183, P<0.05), TG (r=-0.293, P<0.05), and HbA1c (r=-0.238, P<0.05). Vitamin D was inversely associated with duration of T2DM (r=-0.224, P<0.05) and positively associated with BMI (r=0.167, P<0.05). BMD of the lumbar spine in T2DM patients was negatively correlated with age (r=-0.371, P<0.05), HbA1c (r=-0.173, P<0.05), and duration of T2DM (r=-0.230, P<0.05), and positively correlated with BMI (r=0.231, P<0.05). There was a linear regression relationship between BMD of the lumbar spine and age, duration, BMI, HbA1c, PTH, and CTx in T2DM patients. Compared with DXA, quantitative CT had a sensitivity of 100% and specificity of 80.3% in the early diagnosis of type 2 diabetic osteoporosis.

Conclusion

Poor glucose control is associated with decreased bone formation in T2DM patients. Female gender, advanced age, long duration of T2DM, and poor blood glucose control are the main risk factors for OP, while BMI in a certain range is a protective factor for OP. The influence of age, HbA1c, duration of T2DM, PTH, CTx, and BMI on BMD of the lumbar vertebrae gradually increases. Compared with DXA, quantitative CT has greater value in the early diagnosis of type 2 diabetic osteoporosis.

Key words: Type 2 diabetes mellitus, Bone mineral density, Osteoporosis, Bone turnover markers, Quantitative CT

Hui Zhang, Caifeng Yan, Shangyong Feng, Lu Tan, Yingying Ruan, Yihui Gong. Type 2 diabetic osteoporosis: risk factors and early diagnosis by quantitative CT[J]. Chinese Journal of Clinicians(Electronic Edition), 2020, 14(08): 613-618.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2020.08.006

https://zhlcyszz.cma-cmc.com.cn/EN/Y2020/V14/I08/613

Figures/Tables 3

References 13

1	Lundin H, Saaf M, Strender LE, et al. High Serum Insulin-Like Growth Factor-Binding Protein 1 (IGFBP-1) is Associated with High Fracture Risk Independent of Insulin-Like Growth Factor 1 (IGF-I) [J]. Calcif Tissue Int, 2016, 99(4): 333-339.
2	姜艳, 朱志伟, 李玉洁, 等. 2015年美国骨矿盐研究学会(ASBMR)年会热点荟萃 [J]. 中华骨质疏松和骨矿盐疾病杂志, 2016, 9(1): 94-98.
3	Shanbhogue VV, Mitchell DM, Rosen CJ, et al. Type 2 diabetes and the skeleton: new insights intosweet bones [J]. Lancet Diabetes Endocrinol, 2015, 4(2): 159-173.
4	Napoli N, Chandran M, Pierroz DD, et al. Mechanisms of diabetes mellitus-induced bone fragility [J]. Nat Rev Endocrinol, 2017, 13(4): 208-219.
5	Chalhoub D, Orwoll ES, Cawthon PM, et al. Areal and volumetric bone mineral density and risk of multiple types of fracture in older men [J]. Bone, 2016, 92(11): 100-106.
6	Hernlund E, Svedbom A, Ivergård M, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden [J]. Arch Osteoporos, 2013, 8(1): 1-115.
7	Vestergaard P, Rejnmark L, Mosekilde L. Relative fracture risk in patients with diabetes mellitus, and the impact of insulin and oral antidiabetic medication on relative fracture risk [J]. Diabetologia, 2005, 48(7): 1292-1299.
8	Yang J, Zhang X, Wang W, et al. Insulin stimulates osteoblast proliferation and differentiation through ERK and PI3K in MG-63 cells [J]. Cell Biochem Funct, 2010, 28(4): 334-341.
9	Conway BN, Long DM, Figaro MK, et al. Glycemic control and fracture risk in elderly patients with diabetes [J]. Diabetes Res Clin Pract, 2016, 115(5): 47-53.
10	Maycas M, Portoles MT, Matesanz MC, et al. High glucose alters the secretome of mechanically stimulated osteocyte-like cells affecting osteoclast precursor recruitment and differentiation [J]. J Cell Physiol, 2017, 232(12): 3611-3621.
11	Bonnet N. Bone-Derived Factors: A New Gateway to Regulate Glycemia [J]. Calcif Tissue Int, 2017, 100(2): 174-183.
12	Pittas AG, Harris SS, Eliades M, et al. Association between serum osteocalcin and markers of metabolic phenotype [J]. J Clin Endocr Metab, 2013, 94(3): 827.
13	陈国富, 张腊红, 陈兆军. 骨质疏松症患者血清骨钙素与血脂的相关性分析 [J]. 放射免疫学杂志, 2009, 22(5): 489-490.

组别	例数	年龄（岁，±s）	病程（年，±s）	BMI（kg/m²，±s）	FPG（mmol/L，±s）	2hPG（mmol/L，±s）	FCP（ng/ml，±s）	2hCP（ng/ml，±s）	HbA1c（%，±s）
骨质疏松组	88	68.18±9.27	11.06±6.30	24.77±2.62	9.11±2.70	13.27±4.22	1.80±0.85	3.89±2.38	9.90±2.23
非骨质疏松组	132	57.24±12.39	8.94±4.51	26.54±2.61	9.108±2.87	12.96±4.12	1.71±0.84	3.79±2.46	8.98±2.15
统计值	?	t=5.869	t=2.863	t=-3.656	t=0.012	t=0.596	t=0.675	t=0.347	t=2.932
P值	?	<0.001	0.007	<0.001	0.992	0.589	0.436	0.781	0.003
组别	?	HbA1c<7.0%（例）	HbA1c≥7.0%（例）	总胆固醇（mmol/L，±s）	三酰甘油（mmol/L，±s）	HDL-C（mmol/L，±s）	LDL-C（mmol/L，±s）	血钙（mmol/L，±s）	血磷（mmol/L，±s）
骨质疏松组	88	23	65	4.52±1.05	1.61±0.88	1.05±0.29	2.47±0.96	2.28±0.18	1.23±0.25
非骨质疏松组	132	56	76	4.49±1.07	1.49±0.78	1.07±0.28	2.63±0.89	2.29±0.27	1.24±0.26
统计值	?	χ²=9.431		t=0.243	t=1.256	t=-0.251	t=-1.319	t=-0.023	t=-0.207
P值	?	0.004		0.839	0.286	0.836	0.207	0.953	0.854
组别	?	碱性磷酸酶（U/L，±s）	PTH（ng/dl，±s）	CTx（ng/ml，±s）	TP1NP［ng/ml，M（Q_R）］	N-MID［ng/ml，M（Q_R）］	维生素D（ng/ml，±s）	L2~L4椎体骨密度（g/cm²，±s）	肌酐（μmol/L，±s）
骨质疏松组	88	86.06±53.59	42.66±10.22	0.454±0.266	38.5（33.16~46.13）	15.74（13.34~18.20）	14.98±7.96	0.759±0.089	81.55±38.67
非骨质疏松组	132	78.37±35.38	35.66±10.45	0.389±0.145	42.54（38.27~49.49）	17.45（14.27~19.92）	17.67±8.45	1.075±0.078	82.98±43.72
统计值	?	t=1.298	t=3.145	t=2.916	Z=-4.503	Z=-3.879	t=-3.172	t=-4.445	t=-0.193
P值	?	0.238	0.027	0.034	0.001	0.008	0.019	<0.001	0.804

组别	例数	年龄（岁，±s）	病程（年，±s）	BMI（kg/m²，±s）	FPG（mmol/L，±s）	2hPG（mmol/L，±s）	FCP（ng/ml，±s）	2hCP（ng/ml，±s）	HbA1c（%，±s）
骨质疏松组	88	68.18±9.27	11.06±6.30	24.77±2.62	9.11±2.70	13.27±4.22	1.80±0.85	3.89±2.38	9.90±2.23
非骨质疏松组	132	57.24±12.39	8.94±4.51	26.54±2.61	9.108±2.87	12.96±4.12	1.71±0.84	3.79±2.46	8.98±2.15
统计值	?	t=5.869	t=2.863	t=-3.656	t=0.012	t=0.596	t=0.675	t=0.347	t=2.932
P值	?	<0.001	0.007	<0.001	0.992	0.589	0.436	0.781	0.003
组别	?	HbA1c<7.0%（例）	HbA1c≥7.0%（例）	总胆固醇（mmol/L，±s）	三酰甘油（mmol/L，±s）	HDL-C（mmol/L，±s）	LDL-C（mmol/L，±s）	血钙（mmol/L，±s）	血磷（mmol/L，±s）
骨质疏松组	88	23	65	4.52±1.05	1.61±0.88	1.05±0.29	2.47±0.96	2.28±0.18	1.23±0.25
非骨质疏松组	132	56	76	4.49±1.07	1.49±0.78	1.07±0.28	2.63±0.89	2.29±0.27	1.24±0.26
统计值	?	χ²=9.431		t=0.243	t=1.256	t=-0.251	t=-1.319	t=-0.023	t=-0.207
P值	?	0.004		0.839	0.286	0.836	0.207	0.953	0.854
组别	?	碱性磷酸酶（U/L，±s）	PTH（ng/dl，±s）	CTx（ng/ml，±s）	TP1NP［ng/ml，M（Q_R）］	N-MID［ng/ml，M（Q_R）］	维生素D（ng/ml，±s）	L2~L4椎体骨密度（g/cm²，±s）	肌酐（μmol/L，±s）
骨质疏松组	88	86.06±53.59	42.66±10.22	0.454±0.266	38.5（33.16~46.13）	15.74（13.34~18.20）	14.98±7.96	0.759±0.089	81.55±38.67
非骨质疏松组	132	78.37±35.38	35.66±10.45	0.389±0.145	42.54（38.27~49.49）	17.45（14.27~19.92）	17.67±8.45	1.075±0.078	82.98±43.72
统计值	?	t=1.298	t=3.145	t=2.916	Z=-4.503	Z=-3.879	t=-3.172	t=-4.445	t=-0.193
P值	?	0.238	0.027	0.034	0.001	0.008	0.019	<0.001	0.804

参数	β值	SE值	β值	t值	P值
年龄	-0.005	0.001	-0.329	-5.483	<0.001
HbA1c	-0.014	0.005	-0.174	-2.949	<0.001
病程	-0.005	0.002	-0.159	-2.653	0.004
PTH	-0.001	0.001	-0.150	-2.520	0.009
CTx	-0.150	0.051	-0.133	-2.256	0.012
BMI	0.007	0.003	0.131	2.197	0.025
常数	1.337	0.118	?	11.289	<0.001

参数	β值	SE值	β值	t值	P值
年龄	-0.005	0.001	-0.329	-5.483	<0.001
HbA1c	-0.014	0.005	-0.174	-2.949	<0.001
病程	-0.005	0.002	-0.159	-2.653	0.004
PTH	-0.001	0.001	-0.150	-2.520	0.009
CTx	-0.150	0.051	-0.133	-2.256	0.012
BMI	0.007	0.003	0.131	2.197	0.025
常数	1.337	0.118	?	11.289	<0.001

诊断方法	骨质疏松	骨量减少	骨量正常	诊断率（%）
定量CT	114	85	21	51.8
DXA	88	76	56	40.0

Please choose a citation manager

Content to export