Correlation Between Bone Mineral Density And Testosterone In Male Patients With Type 2 Diabetes Mellitus And Its Influencing Factors

Objective: The relationship of sex hormone with bone mineral density was still unclear in male patients with type 2 diabetes.We aim to analyze association of bone mineral density with sex hormone profile and its related factors in male patients with type 2 diabetes.Methods: Select male type 2 diabetic patients who were hospitalized in the Endocrinology Department of our hospital from January 2019 to September 2020 and had six sex hormones and bone mineral density tests,aged 24 to 86 years old.Exclude(1)diagnosed hypopituitary disease,pituitary tumor;(2)have autoimmune diseases;(3)have long-term use of hormones or drugs that affect bone metabolism;(4)have serious underlying diseases(such as liver and kidney Functional failure(Cr>126 μ mol/L),acute severe infection,etc.);(5)Patients with diabetic ketoacidosis,stress state,etc.;(6)Patients with clinical hyperthyroidism and hypothyroidism.According to the detailed medical history,physical examination and male bone mineral density value,the final collected data were relatively complete research subjects of 540 cases.Collect and record the medical history and clinical data of all research subjects,and analyze the data obtained.First collect the general information of the research object: name,hospital number,age,diabetes course(DD),presence or absence of diabetic nephropathy(DN),systolic blood pressure,diastolic blood pressure,height(m),weight(kg),and calculate the body mass index(BMI)): weight(kg)/height 2(m2),waist circumference(cm),etc.Collect blood test indicators of the research subjects,including sex hormone indicators(using ADVIA Centaur XP Siemens automatic chemiluminescence immunoassay analyzer and chemiluminescence method detection): estradiol(E2),follicle-forming hormone(FSH),luteinizing hormone(LH)),progesterone(P),prolactin(PRL),testosterone(TT);other biochemical indicators are determined by the central laboratory of the laboratory of our hospital.Statistical analysis was performed using SPSS 25.0.Results:1.A total of 540 male patients with T2DM who met the research criteria were included,69 of which were osteoporosis(12.9%),the average age was 64.71±9.879 years,the average duration of diabetes was 10.82±6.90 years;274 cases of osteopenia(50.74%)),the average age was 59.92±10.66 years,the average duration of diabetes was 10.70±7.34 years;167 cases had normal bone mass(36.5%),the average age was54.08±12.56 years,and the average duration of diabetes was 9.27±6.96 years.2.A total of 48 of the 540 patients had hypotestosterone(8.9%).Among the 9patients with primary hypo TTemia,1 had osteoporosis(1/9,11.1%),and 39 had secondary Of the patients with hypo TTemia,11 patients suffered from osteoporosis(11/39,28.2%),and among 55 patients with normal compensatory TT level(10.2%),5patients suffered from osteoporosis(5/55,9.1%).Among the 437 patients with normal TT level(80.9%),52 patients suffered from osteoporosis(52/437,11.9%).There was a significant statistical difference in the distribution of osteoporosis in different hypo-TT patients(P<0.05).There is no normal bone mass in patients with primary or secondary hypotestosteroneemia.3.According to the quartile of TT level,as the TT value increases,the incidence of osteoporosis decreases(T1 prevalence rate is 17.3%,T4 prevalence rate is 6.7%,P<0.05);according to E2 quartile,with estradiol The higher the value,the lower the prevalence of osteoporosis(E1 prevalence 19.3%,E4 prevalence 7.4%),but not statistically significant(P=0.076);the prevalence of osteoporosis between LH quartiles No difference(P>0.05);FSH quartile,the higher the FSH,the higher the incidence of osteoporosis(F1 prevalence rate is 7.5%,F4 prevalence rate is 17.0%,P<0.05).4.In male T2DM patients,Spearman correlation analysis found that lumbar spine BMD(L2-L4)was positively correlated with BMI,SBP,LDL-C,creatinine,uric acid,AST,TSH,E2,LH,and PRL(P<0.05),and was positively correlated with ALP Negative correlation(P=0.005);total hip BMD was positively correlated with BMI,DBP,creatinine,UA,AST,Vit D,FT4,E2(P<0.05),and negatively correlated with ALP(P=0.005).5.Age,FT3,FT4,TSH,sex hormones,and other significant parameters in correlation analysis were independent variables.Lumbar BMD was taken as the dependent variable.Multiple linear regression analysis showed that BMI(standardized B= 0.136),CR(0.107),E2(0.114),TT(0.108),were included in the regression equation,and R2=0.110 after adjustment(P=0.044).Multiple linear regression analysis with total hip BMD as the dependent variable showed that age(standardized B =-0.166),BMI(0.236),ALP(-0.115),VD(0.165),LH(0.220),FSH(-0.001)and E2(0.147)were included in the regression equation,and adjusted R2=0.158(P=0.037).Conclusion:More than half of male T2DM patients had osteopenia or OP,and the prevalence of OP in secondary hypotestosterone group was significantly higher than other conditions.In addition to traditional factors,gonadotropins and gonadotropins(high TT,high estrogen,high LH,low FSH)are important BMD protective factors in T2DM patients,while glucose metabolism has limited effect on BMD.