Increased bone density and decreased bone turnover, but no evident alteration of fracture susceptibility in elderly women with diabetes mellitus
Increased bone density and decreased bone turnover, but no evident alteration of fracture susceptibility in elderly women with diabetes mellitus
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DOI：
10.1007/s00198-005-1877-5
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发表时间：
2005-12-01
影响因子：
4
通讯作者：
Obrant, KJ
中科院分区：
文献类型：
--
作者：
Gerdhem, P;Isaksson, A;Obrant, KJ
对1,132名随机招募的75岁女性的骨密度、骨转换和骨折易感性进行了评估。其中74名女性患有糖尿病，而1，058名女性没有。采用双能X线骨密度仪（DXA）测量髋部和腰椎的骨密度（aBMD），超声测量跟骨的骨量。尿脱氧吡啶啉/肌酐（U-DPD/Crea）和血清1型胶原C末端交联端肽（S-CTX）作为骨吸收的标志物进行评估。血清骨特异性碱性磷酸酶（S-bone ALP）和血清骨钙素（S-OC）作为骨形成的标志物进行评估。此外，血清25（OH）维生素D和血清甲状旁腺激素（S-PTH）进行了评估。回顾性和前瞻性评估骨折易感性长达6.5年。与非糖尿病女性相比，糖尿病女性股骨颈aBMD高11%（p < 0.001），腰椎BMD高8%（p =0.002）。跟骨超声检查显示骨量无差异。糖尿病女性在校正体重差异后，股骨颈（p < 0.001）和腰椎（p =0.03）的BMD也较高。在糖尿病女性中，与非糖尿病女性相比，U-DPD/Crea、S-CTX和S-OC降低（p =0.001或更低）。校正体重和血浆肌酐的协方差后，糖尿病女性的S-CTX（p < 0.001）和S-OC（p < 0.001）仍然较低。糖尿病患者有维生素D缺乏症（p =0.008），这种差异可以通过户外活动时间和体重的差异来解释。两组之间的S-PTH没有差异。患有糖尿病的女性（52%）的终生骨折率并不比没有糖尿病的女性（57%）高（p =0.31）。这项研究表明，患有糖尿病且没有严重肾功能不全的老年妇女骨量高，骨转换率低。高骨量和低骨转换不太可能对骨折易感性有很大影响。
Bone density, bone turnover and fracture susceptibility were evaluated in 1,132 randomly recruited women, all 75 years old. Seventy-four of the women had diabetes, while 1,058 women did not. Areal bone mineral density (aBMD) of the hip and lumbar spine was investigated by dual energy X-ray absorptiometry (DXA), and bone mass of the calcaneus was measured by ultrasound. Urinary deoxypyridinoline/creatinine (U-DPD/Crea) and serum C-terminal cross-linked telopeptide of type 1 collagen (S-CTX) were assessed as markers of bone resorption. Serum bone-specific alkaline phosphatase (S-bone ALP) and serum osteocalcin (S-OC) were assessed as markers of bone formation. Also, serum 25(OH) vitamin D and serum parathyroid hormone (S-PTH) were assessed. Fracture susceptibility was evaluated retrospectively and prospectively for up to 6.5 years. In diabetic women, the aBMD of the femoral neck was 11% higher (p < 0.001), and BMD of the lumbar spine was 8% higher ( p =0.002) than in non-diabetic women. There was no difference in bone mass by ultrasound of the calcaneus. Women with diabetes had higher BMD of the femoral neck (p < 0.001) and lumbar spine (p =0.03) also after correction for differences in body weight. In diabetic women, U-DPD/Crea, S-CTX, and S-OC were decreased when compared with non-diabetic women ( p =0.001 or less). After correction for covariance of body weight and plasma creatinine, S-CTX (p < 0.001) and S-OC (p < 0.001) were still lower in the diabetic women. Diabetic patients had hypovitaminosis D (p =0.008), a difference explained by differences in time spent outdoors and body weight. S-PTH did not differ between the groups. Women with diabetes had no more lifetime fractures (52%) than women without diabetic disease (57%), (p =0.31). This study shows that elderly women with diabetes and without severe renal insufficiency have high bone mass and low bone turnover. The high bone mass and low bone turnover is not likely to have a strong influence on fracture susceptibility.