Pentosidine and Increased Fracture Risk in Older Adults with Type 2 Diabetes
Pentosidine and Increased Fracture Risk in Older Adults with Type 2 Diabetes
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DOI：
10.1210/jc.2008-2498
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发表时间：
2009-07-01
影响因子：
5.8
通讯作者：
Bauer, Douglas C.
中科院分区：
文献类型：
--
作者：
Schwartz, Ann V.;Garnero, Patrick;Bauer, Douglas C.
背景：在给定的骨矿物质密度下，2 型糖尿病与较高的骨折风险相关。随着年龄的增长和糖尿病，晚期糖基化终末产物 (AGE) 在骨胶原中积聚，可能会削弱骨骼。目的：目的是确定尿液戊糖苷（一种 AGE）是否与患有或不患有糖尿病的老年人的骨折有关。设计：我们进行了一项观察性队列研究。背景：我们使用来自健康、衰老和身体成分前瞻性研究的数据，该研究针对功能良好的白人和黑人 年龄 70-79 岁的男性和女性。参与者：患有（n = 501）和不患有（n = 427）糖尿病的参与者在性别、种族和研究地点上进行匹配。预测者：从冷冻储存的基线样本中检测尿液戊糖苷。主要结果指标：测量临床骨折和基线椎骨骨折的发生率。结果：尽管骨量较高 糖尿病患者的矿物质密度、临床骨折发生率（14.8% vs. 12.6%）和椎体骨折发生率（2.3% vs. 2.9%）并不低（P > 0.05）。在多变量模型中，戊糖素与糖尿病患者临床骨折发生率增加相关[相对风险，1.42； 95% 置信区间 (CI)，1.10，1.83，对数戊糖苷增加 1 SD]，但在非糖尿病患者中则不然（相对风险，1.08；95% CI，0.79，1.49；交互作用 P 值 = 0.030）。在糖尿病患者中，戊糖素与椎骨骨折发生率增加相关（调整后的比值比，5.93；95% CI，2.08，16.94，对数戊糖素增加 1 SD），但在非糖尿病患者中则不然（调整后的比值比，0.74；95% CI，0.30，1.83；交互作用 P 值 = 0.005）。结论：更高 戊糖素水平是老年糖尿病患者骨折的危险因素，并且可能是 2 型糖尿病患者骨强度降低的部分原因。 (临床内分泌代谢杂志 94: 2380-2386, 2009)
Context: Type 2 diabetes is associated with higher fracture risk at a given bone mineral density. Advanced glycation endproducts (AGEs) accumulate in bone collagen with age and diabetes and may weaken bone.Objective: The aim was to determine whether urine pentosidine, an AGE, was associated with fractures in older adults with and without diabetes.Design: We performed an observational cohort study.Setting: We used data from the Health, Aging and Body Composition prospective study of white and black, well-functioning men and women ages 70-79 yr.Participants: Participants with(n = 501) and with out(n = 427) diabetes were matched on gender, race, and study site.Predictor: Urine pentosidine was assayed from frozen stored baseline specimens.Main Outcome Measures: Incident clinical fractures and baseline vertebral fractures were measured.Results: Despite higher bone mineral density, clinical fracture incidence (14.8 vs. 12.6%) and vertebral fracture prevalence (2.3 vs. 2.9%) were not lower in those with diabetes (P > 0.05). In multivariable models, pentosidine was associated with increased clinical fracture incidence in those with diabetes [relative hazard, 1.42; 95% confidence interval (CI), 1.10, 1.83, for 1 SD increase in log pentosidine] but not in those without diabetes (relative hazard, 1.08; 95% CI, 0.79, 1.49; P value for interaction = 0.030). In those with diabetes, pentosidine was associated with increased vertebral fracture prevalence (adjusted odds ratio, 5.93; 95% CI, 2.08, 16.94, for 1 SD increase in log pentosidine) but not in those without diabetes (adjusted odds ratio, 0.74; 95% CI, 0.30, 1.83; P value for interaction = 0.005).Conclusions: Higher pentosidine levels are a risk factor for fracture in older adults with diabetes and may account in part for reduced bone strength in type 2 diabetes. (J Clin Endocrinol Metab 94: 2380-2386, 2009)