Bone Fractures and Hypoglycemic Treatment in Type 2 Diabetic Patients A case-control study
Bone Fractures and Hypoglycemic Treatment in Type 2 Diabetic Patients A case-control study
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DOI：
10.2337/dc07-1736
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发表时间：
2008-02-01
期刊：
影响因子：
16.2
通讯作者：
Mannucci, Edoardo
中科院分区：
文献类型：
--
作者：
Monami, Matteo;Cresci, Barbara;Mannucci, Edoardo
目的：降糖治疗可以在许多方面调节骨折的风险。大多数研究没有探索单独的口服降糖剂对骨折发生率的影响，而是所有口服治疗作为一个整体。这项病例对照研究嵌套在一个回顾性队列中，目的是评估暴露于胰岛素或不同口服降糖剂对骨折风险的影响。研究设计和方法：对1,945名糖尿病门诊患者进行病例对照研究，随访4.1+/-2.3年，比较83例骨折病例和249名对照受试者在年龄、性别、糖尿病病程、体重指数、AIC、合并症、吸烟和酗酒方面的匹配。研究人员对事件发生前10年(或匹配的指标日期)的降糖药物暴露情况进行了评估。结果：在一个模型中，在过去的1.0年中，至少36个月使用胰岛素促分泌剂、二甲双胍和胰岛素治疗，未发现骨折与药物治疗之间的显著关联。在所有考虑骨折时治疗的替代模型中，在男性中，胰岛素治疗与骨折显著相关(OR 3.20[5%CI 1.32-7.74])，而在女性中不相关(1.41[0.73-2.73])。服用二甲双胍与骨折发生率无关，提示噻唑烷二酮类药物的负面作用是由于对骨代谢的特定作用，而不是降低胰岛素血症。相反，目前的胰岛素治疗增加了骨折的风险；同时，长期接触这种药物似乎不会影响骨骼脆弱。
OBJECTIVE - Hypoglycemic treatments could modulate the risk for fractures in many ways. Most Studies have not explored the effect Oil the incidence of bone fractures of individual oral hypoglycemic agents, rather all oral treatments as a whole. The aim of this case-control study, nested within a retrospective cohort, is the assessment of the risk for bone fractures associated With exposure to insulin or different oral hypoglycemic agents.RESEARCH DESIGN AND METHODS - A case-control Study nested within a cohort of 1,945 diabetic outpatients with a follow-up of 4.1 +/- 2.3 years was performed, comparing 83 case subjects of bone fractures and 249 control subjects matched for age, sex, duration of diabetes, BMI, AIC, comorbidity, smoking, and alcohol abuse. Exposure to hypoglycemic drugs during the 10 years preceding the event (or matching index date) was assessed.RESULTS - in a model including treatment with insulin secretagogues metformin and insulin for at least 36 months during the previous 1.0 years, no significant association was observed between bone fractures and medications. In ail alternative model considering treatments at the time of fracture, insulin treatment was significantly associated With bone fractures in men (OR 3.20 [5% CI 1.32-7.74]) but not in women (1.41 [0.73-2.73]).CONCLUSIONS - Insulin-sensitizing treatment. With metformin is not associated With a higher incidence of bone fractures, suggesting that the negative effect of thiazolidinediones is due to a specific action on bone metabolism rather a reduction of insulinemia. Conversely, current treatment with insulin increases the risk of fractures; at the same time, exposure to this agent in the longer term does not appear to affect bone frailty.