Type 1 diabetes patients have lower strength in femoral bone determined by quantitative computed tomography: A cross-sectional study.
Type 1 diabetes patients have lower strength in femoral bone determined by quantitative computed tomography: A cross-sectional study.
复制标题
DOI：
10.1111/jdi.12372
复制
发表时间：
2015-11
影响因子：
3.2
通讯作者：
Hirano T
中科院分区：
文献类型：
--
作者：
Ishikawa K;Fukui T;Nagai T;Kuroda T;Hara N;Yamamoto T;Inagaki K;Hirano T
先前的研究报告了在年轻的1型糖尿病患者中通过双能X线骨密度仪测量的骨质疏松症。然而，2-D成像的局限性限制了双能X射线吸收法测量骨矿物质密度和骨强度的精度。三维定量计算机断层扫描被用来计算体积骨矿物质密度（vBMD）和强度在股骨骨亚组。本横断面研究共调查了17例男性1型糖尿病患者和18例性别匹配的健康对照者，年龄18 ~ 49岁。排除明显肾病患者。1型糖尿病患者股骨颈的皮质vBMD显著较低，转子间的总vBMD、皮质厚度和皮质横截面积（皮质CSA）显著较低。1型糖尿病患者的股骨粗隆间屈曲比（皮质不稳定性的一个指标）评估的骨强度明显更高。以下血清骨标志物在两组之间具有可比性：骨特异性碱性磷酸酶、1型前胶原N-末端前肽、骨钙素、戊糖苷和同型半胱氨酸。1型糖尿病患者血清胰岛素样生长因子-1值显著低于对照组。1型糖尿病患者血清胰岛素样生长因子-1值与血清骨形成标志物、股骨颈和腰椎总vBMD呈正相关。本研究是首次通过定量计算机断层扫描测量来显示年轻和中年1型糖尿病患者转子间皮质不稳定和vBMD较低的调查。低胰岛素样生长因子-1可能是1型糖尿病骨质疏松的一个致病因素。
Previous studies have reported osteoporosis measured by dual-energy X-ray absorptiometry in younger patients with type 1 diabetes. Limitations of 2-D imaging, however, limit the precision of dual-energy X-ray absorptiometry for the measurement of bone mineral density and bone strength. Three-dimensional quantitative computed tomography was used to calculate volumetric-bone mineral density (vBMD) and strength in femoral bone subfractions. A total of 17 male type 1 diabetes patients and 18 sex-matched healthy controls aged from 18 to 49 years were investigated in the present cross-sectional study. Patients with overt nephropathy were excluded. Type 1 diabetes patients had significantly lower cortical vBMD in the femoral neck, and significantly lower total vBMD, cortical thickness and cortical cross-sectional area (cortical CSA) in the intertrochanter. Bone strength estimated by the buckling ratio (an index of cortical instability) of the intertrochanter was significantly higher in type 1 diabetes patients. The following serum bone markers were comparable between the two groups: bone-specific alkaline phosphatase, N-terminal propeptide of type 1 procollagen, osteocalcin, pentosidine and homocysteine. Serum insulin-like growth factor-1 values were significantly lower in the type 1 diabetes patients than in controls. Serum insulin-like growth factor-1values were positively correlated with serum bone formation markers, and the total vBMD of the femoral neck and lumbar spine in type 1 diabetes patients. The present study is the first investigation by quantitative computed tomography measurement to show cortical instability and lower vBMD in the intertrochanter of young and middle-aged type 1 diabetes patients. Low insulin-like growth factor-1 might be a causative factor for osteoporosis in type 1 diabetes.