A Bone Structural Basis for Fracture Risk in Diabetes
A Bone Structural Basis for Fracture Risk in Diabetes
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DOI：
10.1210/jc.2008-0639
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发表时间：
2008-12-01
影响因子：
5.8
通讯作者：
Khosla, Sundeep
中科院分区：
文献类型：
--
作者：
Melton, L. Joseph, III;Riggs, B. Lawrence;Khosla, Sundeep
背景：2型糖尿病患者面骨矿物质密度（aBMD）升高与某些骨骼部位骨折风险增加不一致。目的：由于aBMD是一个不完善的骨强度替代物，我们使用定量计算机断层扫描更直接地评估骨结构和强度。设计：在横断面研究中对糖尿病和非糖尿病受试者进行评估。背景：受试者是从明尼苏达州罗切斯特市随机抽取的。参与者：49名2型糖尿病患者（28名女性和21名男性）与年龄和性别匹配的非糖尿病对照组进行了比较。主要结果测量：我们测量了髋关节、脊柱和手腕的骨几何形状、强度和体积骨密度（vBMD），以及髋关节aBMD，使用中央和周围定量计算机断层扫描，并估计了每个部位的骨负荷与骨强度之比。结果：调整了病例和对照组之间的体重指数差异（29.8 vs 27.6），糖尿病患者的臀部aBMD更高，但这是由于小梁vBMD更高。两组的皮质vBMD、骨截面积和皮质厚度相似。糖尿病患者的骨强度测量结果通常更好，但由于体重增加，骨负荷也更高。因此，载荷强度比（即风险因素）是相似的。结论：2型糖尿病患者在改善骨负荷与强度比方面从aBMD升高中获益甚微。由于没有骨密度缺陷，糖尿病患者进行抗吸收治疗的理由尚不确定，但糖尿病对骨质量的潜在不良影响需要更多的研究。[J] .中华内分泌杂志，2008,31(3):481 - 481。
Context: Elevated areal bone mineral density (aBMD) in type 2 diabetes mellitus is inconsistent with increased fracture risk at some skeletal sites.Objectives: Because aBMD is an imperfect surrogate for bone strength, we assessed bone structure and strength more directly using quantitative computed tomography.Design: Diabetic and nondiabetic subjects were evaluated in a cross-sectional study.Setting: Subjects were recruited from a random sample of the Rochester, MN, population.Participants: Forty-nine subjects (28 women and 21 men) with type 2 diabetes were compared with age- and sex-matched nondiabetic controls.Main Outcome Measurements: We measured bone geometry, strength, and volumetric BMD (vBMD) at the hip, spine, and wrist, along with hip aBMD, using central and peripheral quantitative computed tomography and estimated bone load to bone strength ratios at each site.Results: Adjusted for differences in body mass index between cases and controls (29.8 vs. 27.6), hip aBMD was greater in diabetic subjects, but this was accounted for by greater trabecular vBMD. Cortical vBMD was similar in the two groups, as was bone cross-sectional area and cortical thickness. Bone strength measures were generally better in diabetic subjects, but bone loads were higher from their greater weight. Consequently, load to strength ratios (i.e. factor-of-risk) were similar.Conclusions: Patients with type 2 diabetes enjoy little benefit from elevated aBMD in terms of improved bone load to strength ratios. With no deficit in bone density, the rationale for antiresorptive therapy in diabetic patients is uncertain, but potential adverse effects of diabetes on bone quality need more study. (J Clin Endocrinol Metab 93: 4804-4809, 2008)