PREVALENCE AND MAGNITUDE OF OSTEOPENIA ASSOCIATED WITH INSULIN-DEPENDENT DIABETES-MELLITUS
PREVALENCE AND MAGNITUDE OF OSTEOPENIA ASSOCIATED WITH INSULIN-DEPENDENT DIABETES-MELLITUS
复制标题
DOI：
10.1016/1056-8727(94)90058-2
复制
发表时间：
1994-04-01
影响因子：
3
通讯作者：
VIEIRA, JGH
中科院分区：
文献类型：
--
作者：
KAYATH, MJ;DIB, SA;VIEIRA, JGH
作者评价了胰岛素依赖型糖尿病（IDDM）中骨质减少的患病率、程度和影响因素。 我们用双能X线骨密度仪测量了90例18-54岁的IDDM患者腰椎和股骨的骨密度。 评估血糖控制、胰岛素剂量、病程和糖尿病慢性并发症的存在。 还分析了血清离子钙、镁、磷、碱性磷酸酶（ALP）、25-羟基胆钙化醇、免疫反应性甲状旁腺激素（iPTH）和尿钙、磷和羟脯氨酸。 31例患者（34%）被归类为BMD降低（低于平均值小于2 SD）。 正常与低骨密度患者的比较显示，骨质减少患者有年轻化的趋势（中位数，28岁对32岁），显示平均血糖较高（15.5 +/- 5.0 mmol/L vs 12.9 +/- 3.8 mmol/L; p = 0.018），疾病持续时间较长（11.2 +/- 2.1年对5.0 +/- 1.3年; p = 0.004），并且需要更高的胰岛素剂量（56 +/- 17} U/天对43 +/- 16 U/天; p < 0.001）。 平均血糖水平、病程、胰岛素剂量和骨量减少之间呈正相关。 低BMD组慢性并发症的发生率较高，主要是视网膜病变（58%对25%）和神经病变（52%对22%）。 血清钙、磷、iPTH、25-羟胆钙化醇和尿钙、磷均无变化。 ALP水平在骨质减少组中显著升高，镁和羟脯氨酸水平在整个糖尿病组中均较低，但这些测量值与BMD降低无关。 骨质减少应被认为是控制不佳患者的慢性并发症，并与较长的病程和其他IDDM慢性并发症有关。 （Journal of Diabetes and Its Complications 8;2：97-104，1994.）
The authors evaluated the prevalence, magnitude, and contributing factors for osteopenia in insulin-dependent diabetes mellitus (IDDM). We measured bone mineral density (BMD) in the lumbar spine and femoral region in 90 patients aged 18-54 years with IDDM using dual-energy x-ray absorptiometry. The blood-glucose control, insulin dosage, duration of disease, and presence of chronic complications of diabetes were evaluated. Serum ionized calcium, magnesium, phosphorus, alkaline phosphatase (ALP), 25-hydroxycholecalciferol, immunoreactive parathyroid hormone (iPTH), and urinary calcium, phosphorus, and hydroxyproline were also analyzed. Thirty-one patients (34%) were classified as having a reduced BMD (less than 2 SD below the mean). The comparison between normal and low BMD patients showed that the osteopenics had a tendency to be younger (median, 28 years versus 32 years), showed a higher mean plasma glucose (15.5 +/- 5.0 mmol/L versus 12.9 +/- 3.8 mmol/L; p = 0.018), longer duration of disease (11.2 +/- 2.1 years versus 5.0 +/- 1.3 years; p = 0.004), and needed a higher insulin dosage (56 +/- 17} U/day versus 43 +/- 16 U/day; p < 0.001). There was a positive correlation between mean glucose levels, duration of disease, insulin dosage, and bone-mass decrease. A higher incidence of chronic complications, mainly retinopathy (58% versus 25%) and neuropathy (52% versus 22%) was found in the low BMD group. There was no alteration of serum calcium, phosphorus, iPTH, 25-hydroxycholecalciferol, and urinary calcium and phosphorus. The ALP levels were significantly higher in the osteopenic group, and magnesium and hydroxyproline levels were lower in the whole diabetic group, but these measurements did not correlate with BMD reduction. Osteopenia should be considered as a chronic complication of poorly controlled patients, and is associated with longer disease duration and other IDDM chronic complications. (Journal of Diabetes and Its Complications 8;2:97-104, 1994.)