老年糖尿病女性繼發性骨質疏松及其相關骨折_《中國循證醫學雜志》

作者：

王曉平 ¹ ,  丁洪流 ²

1.上海交通大學附屬上海市第一人民醫院（上海?200080）2.美國麻省大學梅耶醫學研究所（Massachusetts, U.S.A.）;

關鍵詞：

糖尿病骨質疏松骨折相關性分析

DOI：

10.7507/1672-2531.20080121

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　繼發性骨質疏松在原發性骨質疏松病人中很常見。糖尿病為已知繼發性骨質疏松病因之一。雖然I型糖尿病和糖尿病性骨質疏松有明確聯系，但II型糖尿病對骨質健康的影響頗具爭議。
方法　調查WHI參試者中II型糖尿病與骨質疏松及在不同骨骼部位的骨折的關系。
結果　對此研究人群一些常見危險因素諸如年齡、種族、體密度指標、是否采用激素替代療法、既往骨折史與骨質疏松及骨折顯著相關。糖尿病女性似具降低的骨質疏松患病危險，但此現象在調節其他危險因素后不再顯著［調節前HR=0.78，95%CI（0.61，0.99）；調節后HR=0.93，95%CI（0.73，1.19）］。糖尿病對骨折的影響在不同的骨骼部位有所變化。在糖尿病女性中髖部骨折危險顯著增加［HR=2.54，95%CI（1.14，5.66）］，但未見脊柱骨折危險［HR=1.71，95%CI（0.81，3.60）］及手臂骨折危險［HR=0.92，95%CI（0.48，1.76）］有顯著變化。盡管總體骨折危險在糖尿病與非糖尿病女性中，無明顯不同［HR=1.37，95%CI（0.89，2.09）］，但在隨訪2 000天后可見，糖尿病患者危險增加兩倍并具有統計學意義［HR=2.01，95%CI（1.21，3.35）］，提示糖尿病不同階段的危害不同。
結論　我們的發現顯示II型糖尿病或許與骨質疏松沒有明確聯系，但其至少特異性增加髖部骨折。此外，總體骨折危險呈時間依賴式增長。

引用本文： 王曉平,丁洪流. 老年糖尿病女性繼發性骨質疏松及其相關骨折. 中國循證醫學雜志, 2008, 08(7): 517-524. doi: 10.7507/1672-2531.20080121 復制

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16.	Okuno Y, Nishizawa Y, Sekiya K, et al. Total and regional bone mineral content in patients with non-insulin-dependent diabetes mellitus. J Nutr Sci Vitaminol (Tokyo), 1991, 37(suppl): S43-S49.
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18.	Hampson G, Evans C, Petitt RJ, et al. Bone mineral density, collagen type 1 alpha 1 genotypes and bone turnover in premenopausal women with diabetes mellitus. Diabetologia, 1998, 41: 1314-1320.
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21.	Barrett-Connor E, Holbrook TL. Sex differences in osteoporosis in older adults with non-insulin-dependent diabetes mellitus. JAMA, 1992, 268: 3333-3337.
22.	Isaia GC, Ardissone P, Di Stefano M, et al. Bone metabolism in type 2 diabetes mellitus. Acta Diabetol, 1999, 36: 35-38.
23.	Schwartz AV, Sellmeyer DE, Ensrud KE, et al. Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab, 2001, 86: 32-38.
24.	Nicodemus KK, Folsom AR. Type 1 and type 2 diabetes and incident hip fractures in postmenopausal women. Diabetes Care, 2001, 24: 1192-1197.
25.	Forsen L, Meyer HE, Midthjell K, et al. Diabetes mellitus and the incidence of hip fracture: results from the Nord-Trondelag Health Survey. Diabetologia, 1999, 42: 920-925.
26.	Meyer HE, Tverdal A, Falch JA. Risk factors for hip fracture in middle-aged Norwegian women and men. Am J Epidemiol, 1993, 137: 1203-1211.
27.	Ottenbacher KJ, Ostir GV, Peek MK, et al. Diabetes mellitus as a risk factor for hip fracture in Mexican American older adults. J Gerontol A Biol Sci Med Sci, 2002, 57: M648-653.
28.	Keegan TH, Kelsey JL, Sidney S, et al. Foot problems as risk factors of fractures. Am J Epidemiol, 2002, 155: 926-931.
29.	Majima T, Komatsu Y, Yamada T, et al. Decreased bone mineral density at the distal radius, but not at lumbar spine or the femoral neck, in Japanese type 2 diabetic patients. Osteoporosis Int, 2005, 16: 907-913.
30.	Schwartz AV, Hillier TA, Sellmeyer DE, et al. Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care, 2002, 25(10):1749-1754.
31.	Haffner SM, Bauer RL. The association of obesity and glucose and insulin concentrations with bone density in premenopausal and postmenopausal women. Metabolism, 1993, 42: 735-738.
32.	Reid IR, Evans MC, Cooper GJ, et al. Circulating insulin levels are related to bone density in normal postmenopausal women. Am J Physiol, 1993, 265: E655-659.
33.	Stolk RP, van Daele PL, Pols HA, et al. Hyperinsulinemia and bone mineral density in an elderly population: The Rotterdam Study. Bone, 1996, 18: 545-549.
34.	Barrett-Connor E, Kritz-Silverstein D. Does hyperinsulinemia preserve bone? Diabetes Care, 1996, 19: 1388–1392.

1. National Osteoporosis Foundation: available at http://www.nof.org/osteoporosis/diseasefacts.htm. Accessed: January 11, 2008.
2. Cooper C. Epidemiology of osteoporosis. Osteoporos Int, 1999, 9(Suppl 2): S2-8.
3. Stein E & Shane E. Secondary osteoporosis. Endocrinology and Metabolism Clinics of North America, 2003, 1: 115-134.
4. Tuominen JT, Impivaara O, Puukka P, et al. Bone mineral density in patients with type 1 and type 2 diabetes. Diabetes Care, 1999, 22: 1196-1200.
5. McNair P, Christiansen C, Christensen MS, et al. Development of bone mineral loss in insulin-treated diabetes: a 112 years follow-up study in sixty patients. Eur J Clin Invest, 1981, 11: 55-59.
6. Forst T, Pfutzner A, Kann P, et al. Peripheral osteopenia in adult patients with insulin-dependent diabetes mellitus. Diabetes Med, 1995, 12: 874-879.
7. Buysschaert M, Cauwe F, Jamart J, et al. Proximal femur density in type 1 and 2 diabetic patients. Diabetes Metab, 1992, 18: 32-37.
8. Hui SL, Epstein S, Johnston Jr CC. A prospective study of bone mass in patients with type I diabetes. J Clin Endocrinol Metab, 1985, 60: 74-80.
9. Miazgowski T, Czekalski S. A 2-year follow-up study on bone mineral density and markers of bone turnover in patients with long-standing insulin-dependent diabetes mellitus. Osteoporos Int, 1998, 8: 399-403.
10. Mathiassen B, Nielsen S, Johansen JS, et al. Long-term bone loss in insulin-dependent diabetic patients with microvascular complications. J Diabetes Complications, 1990, 4: 145-149.
11. Levin ME, BoisseauVC, Avioli LV. Effects of diabetes mellitus on bone mass in juvenile and adult-onset diabetes. N Engl J Med, 1976, 294: 241-245.
12. Gregorio F, Cristallini S, Santeusanio F, et al. Osteopenia associated with non-insulindependent diabetes mellitus: What are the causes? Diabetes Res Clin Pract, 1994, 23: 43-54.
13. Krakauer JC, McKenna MJ, Buderer NF, et al. Bone loss and bone turnover in diabetes. Diabetes, 1995, 44: 775-782.
14. Kao CH, TsouCT, Chen CC, et al. Bone mineral density in patients with noninsulin-dependent diabetes mellitus by dual photon absorptiometry. Nucl Med Commun, 1993, 14: 373-377.
15. Wakasugi M, Wakao R, Tawata M, et al. Bone mineral density measured by dual energy x-ray absorptiometry in patients with non-insulindependent diabetes mellitus. Bone, 1993, 14: 29-33.
16. Okuno Y, Nishizawa Y, Sekiya K, et al. Total and regional bone mineral content in patients with non-insulin-dependent diabetes mellitus. J Nutr Sci Vitaminol (Tokyo), 1991, 37(suppl): S43-S49.
17. van Daele PL, Stolk RP, Burger H, et al. Bone density 518 A. V. Schwartz: Diabetes and Bone in non-insulin-dependent diabetes mellitus. The Rotterdam Study. Ann Intern Med, 1995, 122: 409-414.
18. Hampson G, Evans C, Petitt RJ, et al. Bone mineral density, collagen type 1 alpha 1 genotypes and bone turnover in premenopausal women with diabetes mellitus. Diabetologia, 1998, 41: 1314-1320.
19. Bauer DC, Browner WS, Cauley JA, et al. Factors associated with appendicular bone mass in older women. The Study of Osteoporotic Fractures Research Group. Ann Intern Med, 1993, 118: 657-665.
20. Orwoll ES, Bauer DC, Vogt TM, et al. Axial bone mass in older women. Study of Osteoporotic Fractures Research Group. Ann Intern Med, 1996, 124: 187-196.
21. Barrett-Connor E, Holbrook TL. Sex differences in osteoporosis in older adults with non-insulin-dependent diabetes mellitus. JAMA, 1992, 268: 3333-3337.
22. Isaia GC, Ardissone P, Di Stefano M, et al. Bone metabolism in type 2 diabetes mellitus. Acta Diabetol, 1999, 36: 35-38.
23. Schwartz AV, Sellmeyer DE, Ensrud KE, et al. Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab, 2001, 86: 32-38.
24. Nicodemus KK, Folsom AR. Type 1 and type 2 diabetes and incident hip fractures in postmenopausal women. Diabetes Care, 2001, 24: 1192-1197.
25. Forsen L, Meyer HE, Midthjell K, et al. Diabetes mellitus and the incidence of hip fracture: results from the Nord-Trondelag Health Survey. Diabetologia, 1999, 42: 920-925.
26. Meyer HE, Tverdal A, Falch JA. Risk factors for hip fracture in middle-aged Norwegian women and men. Am J Epidemiol, 1993, 137: 1203-1211.
27. Ottenbacher KJ, Ostir GV, Peek MK, et al. Diabetes mellitus as a risk factor for hip fracture in Mexican American older adults. J Gerontol A Biol Sci Med Sci, 2002, 57: M648-653.
28. Keegan TH, Kelsey JL, Sidney S, et al. Foot problems as risk factors of fractures. Am J Epidemiol, 2002, 155: 926-931.
29. Majima T, Komatsu Y, Yamada T, et al. Decreased bone mineral density at the distal radius, but not at lumbar spine or the femoral neck, in Japanese type 2 diabetic patients. Osteoporosis Int, 2005, 16: 907-913.
30. Schwartz AV, Hillier TA, Sellmeyer DE, et al. Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care, 2002, 25(10):1749-1754.
31. Haffner SM, Bauer RL. The association of obesity and glucose and insulin concentrations with bone density in premenopausal and postmenopausal women. Metabolism, 1993, 42: 735-738.
32. Reid IR, Evans MC, Cooper GJ, et al. Circulating insulin levels are related to bone density in normal postmenopausal women. Am J Physiol, 1993, 265: E655-659.
33. Stolk RP, van Daele PL, Pols HA, et al. Hyperinsulinemia and bone mineral density in an elderly population: The Rotterdam Study. Bone, 1996, 18: 545-549.
34. Barrett-Connor E, Kritz-Silverstein D. Does hyperinsulinemia preserve bone? Diabetes Care, 1996, 19: 1388–1392.

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老年糖尿病女性繼發性骨質疏松及其相關骨折

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《中國循證醫學雜志》

老年糖尿病女性繼發性骨質疏松及其相關骨折

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