Type 2 Diabetes Mellitus Is Associated With Better Bone Microarchitecture But Lower Bone Material Strength and Poorer Physical Function in Elderly Women: A Population-Based Study
Type 2 Diabetes Mellitus Is Associated With Better Bone Microarchitecture But Lower Bone Material Strength and Poorer Physical Function in Elderly Women: A Population-Based Study
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DOI：
10.1002/jbmr.3057
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发表时间：
2017-05-01
影响因子：
6.2
通讯作者：
Lorentzon, Mattias
中科院分区：
文献类型：
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作者：
Nilsson, Anna G.;Sundh, Daniel;Lorentzon, Mattias
根据多项研究，2型糖尿病(T2 DM)与骨折风险增加有关。其潜在机制尚不清楚，尽管小型病例对照研究表明皮质骨质量较差。我们研究了哥德堡75岁至80岁女性的人口样本，这些样本是从人口登记处随机抽取的。采用双能X线骨密度仪测量骨密度(ABMD)，高分辨率外周定量计算机断层扫描(HR-pQCT；Sanco Medical AG ExtremeCT)测量骨微结构，应用OsteoProbe(Active Life Science)进行参考点压痕测量。女性T2 DM患者(n=99)骨密度高于正常对照组(n=954)。糖尿病组胫骨和桡骨远端骨小梁体积分数(分别为+11%和+15%)、远端皮质体积骨密度(+1.6%和+1.7%)、皮质面积(+11.5%和+9.3%)和破坏载荷(+7.7%和+12.9%)均高于对照组。T2 DM患者的皮质孔隙率在桡骨远端较低(平均+/-SD：1.5%+/-1.1%对2.0%+/-1.7%，p=0.001)，而在桡骨远端和胫骨则无明显差异。调整协变量(年龄、体重指数、糖皮质激素治疗、吸烟、体力活动、钙摄入量、骨活性药物)消除了aBMD的差异，但不消除HR-pQCT骨变量的差异。然而，根据参考点压痕计算的骨材料强度指数(BMSi)在T2 DM组较低(74.6+/-7.6比78.2+/-7.5，p
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of fractures according to several studies. The underlying mechanisms remain unclear, although small case-control studies indicate poor quality of the cortical bone. We have studied a population-based sample of women aged 75 to 80 years in Gothenburg, randomly invited from the population register. Areal bone mineral density (aBMD) was measured by dual-energy X-ray absorptiometry (Hologic Discovery A), bone microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT; ExtremeCT from Scanco Medical AG), and reference point indentation was performed with Osteoprobe (Active Life Scientific). Women with T2DM (n=99) had higher aBMD compared to controls (n=954). Ultradistal tibial and radial trabecular bone volume fraction (+11% and +15%, respectively), distal cortical volumetric BMD (+1.6% and +1.7%), cortical area (+11.5% and +9.3%), and failure load (+7.7% and +12.9%) were higher in diabetics than in controls. Cortical porosity was lower (mean +/- SD: 1.5%+/- 1.1% versus 2.0%+/- 1.7%, p=0.001) in T2DM in the distal radius but not in the ultradistal radius or the tibia. Adjustment for covariates (age, body mass index, glucocorticoid treatment, smoking, physical activity, calcium intake, bone-active drugs) eliminated the differences in aBMD but not in HR-pQCT bone variables. However, bone material strength index (BMSi) by reference point indentation was lower in T2DM (74.6 +/- 7.6 versus 78.2 +/- 7.5, p