Type 2 diabetes mellitus in nursing home patients:: Effects on bone turnover, bone mass, and fracture risk
Type 2 diabetes mellitus in nursing home patients:: Effects on bone turnover, bone mass, and fracture risk
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DOI：
10.1210/jc.2006-0460
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发表时间：
2006-09-01
影响因子：
5.8
通讯作者：
Fahrleitner-Pammer, Astrid
中科院分区：
文献类型：
--
作者：
Dobnig, Harald;Piswanger-Soelkner, Jutta Claudia;Fahrleitner-Pammer, Astrid
背景：骨折是住院老年人的主要健康负担。2型糖尿病（DM）在养老院患者中发病率很高，并且对年轻的社区老年人的骨量有积极影响。目的：本研究的目的是调查2型糖尿病是否会影响居住在养老院的体弱老年妇女的骨量、骨转换或预期骨折率。设计、环境和参与者：本研究是一项前瞻性队列研究，从奥地利95家养老院招募了583名2型糖尿病患者和1081名70岁以上的对照（CTR）个体。患者入组并由流动研究小组进行随访。主要观察指标：我们对跟骨、桡骨和近端第三指骨进行了定量骨超声测量，测量了股四头肌强度，以及矿物质代谢和骨转换的生化参数。前瞻性随访患者髋部和其他非椎体骨折超过2年。结果：与CTRs相比，2型DM患者的年龄、体重和活动度评分调整后的跟骨刚度（P < 0.0001）、径向声速（P < 0.005）和指骨声速（P < 0.05）测量值明显更高。2型糖尿病患者的平均血清PTH（-20.7%）和骨钙素水平（-22.3%）均显著降低（P < 0.0001），尽管与对照组相比，血清25-羟基维生素D水平较低，调整后的血清总钙水平略高。在两组患者中，骨转换的重要独立决定因素是甲状旁腺激素、肌酐清除率、丙氨酸转氨酶以及糖化血红蛋白水平，它们共同占其方差的30-40%。观察期间共发生110例髋部骨折，对应于每100例患者年髋部骨折率为3.1%（在CTRs中）和3.4%（在2型糖尿病中）；这在中转组和糖尿病患者中没有显著差异。结论：PTH水平降低和血糖水平升高是老年2型糖尿病患者骨转换降低的独立原因。尽管骨量较高，骨转换较低，但髋部骨折的风险与无糖尿病的女性相当。
Context: Fractures are a major health burden in elderly institutionalized persons. Type 2 diabetes mellitus (DM) has a high prevalence in nursing home patients and has been associated with positive effects on bone mass in younger, community-dwelling elderly.Objective: The objective of this study was to investigate whether type 2 DM affects bone mass, bone turnover, or prospective fracture rates in frail, elderly women living in nursing homes.Design, Setting, and Participants: This study was a prospective cohort of 583 patients with type 2 DM and 1081 control (CTR) individuals above age 70 recruited from 95 nursing homes in Austria. Patients were enrolled and followed up by mobile study teams.Main Outcome Measures: We performed quantitative bone ultrasound measurements at the calcaneus, radius, and proximal third phalanx, measurements of quadriceps strength, and biochemical parameters of mineral metabolism and bone turnover. Patients were prospectively followed for hip and other nonvertebral fractures over 2 yr.Results: Patients with type 2 DM had significantly higher age-, weight-, and mobility score-adjusted calcaneal stiffness (P < 0.0001), radial speed of sound (P < 0.005), and phalangeal speed of sound (P < 0.05) measurements when compared with CTRs. Mean serum PTH (-20.7%) and osteocalcin levels (-22.3%) were significantly lower (both P < 0.0001) in patients with treated type 2 DM despite comparable low serum 25-hydroxyvitamin D levels and slightly higher adjusted total serum calcium levels compared with CTRs. Important independent determinants of bone turnover in both patient groups were PTH, creatinine clearance, alanine aminotransferase, as well as glycosylated hemoglobin levels, together accounting for 30-40% of its variance. A total of 110 hip fractures occurred during the observation period, corresponding to a hip fracture rate of 3.1% (in CTRs) and 3.4% (in type 2 DM) per 100 patient years; this was not significantly different for CTRs and diabetics.Conclusions: Decreased PTH levels and higher levels of glycemia independently contribute to lower bone turnover in elderly nursing home patients with type 2 DM. Despite higher bone mass and lower bone turnover, hip fracture risk is comparable with women without DM.