Correlation Analysis Of Bone Mineral Density With Atherosclerosis And Insulin Resistance Index In Patients With Type 2 Diabetes

Objective :In this study,we analyzed the correlation between bone mineral density(BMD)and carotid intima-media thickness(CIMT),carotid vascular resistance index(RI)and Insulin resistance(IR)index in patients with type 2 diabetes(T2DM).method: Selecting 300 T2DM patients who were hospitalized in endocrinology department of a Class III A hospital from January 2019 to October 2020,collecting the general data of each patient,such as sex,age,height,weight,smoking history,drinking history,hypertension history and stroke history,and measuring fasting plasma glucose(FPG),fasting c-peptide(FCP),glycosylated hemoglobin(HBA1c)and Serum lipid.BMD values of lumbar vertebrae(L1-L4),femoral region and hip joint were measured by dual-energy x-ray absorptiometry(DXA).According to BMD value,they were divided into normal bone mass group(n=150)and low bone mass group(n=150).Meanwhile,the CIMT,resistance index(RI)and plaque formation were detected by color Doppler ultrasound.Measurement data were expressed as mean standard deviation,and inter-group comparison was examined by independent sample t test.Enumeration data were expressed as frequency(percentage),and inter-group comparison was examined by Chi-square test.Pearson correlation analysis,binary Logistic regression analysis and ROC curve were drawn between BMD and the variable with statistical difference.P<0.05 indicated that the difference was statistically significant.Results1.Compared with the normal bone mass group(n=150),the low bone mass group(n=150)had a longer course of diabetes(14.10±6.41 vs 9.83±7.11,t =-5.461,p<0.001),a lower BMI(23.21±2.70 vs 24.06±6.81,t=2.661,p=0.008),a higher age(64.12±9.79 vs59.23±9.31,t =-4.429,p<0.001),higher HOMAIR values(4.98±1.93 vs 3.89±2.42,t =-4.279,p<0.001),more history of stroke(16.7%vs6.0%,χ~2= 8.492,p=0.004),more histo-ry of smoking(50.7% vs 24.7%,χ~2= 21.594,p<0.001),more alcohol use(28.7% vs 14.0%,χ~2= 9.613,p=0.002),more hyperlipidemia(32.0%vs5.3%,χ~2= 35.129,p<0.001),mo-re carotid plaque formation(32.0%vs7.3%,χ~2 = 28.884,p<0.001),higher CIMT(0.95±0.31vs0.68±0.15,t=-9.634,p<0.001),and higher RI value(0.75±0.09vs0.68±0.07,t=-7.571,p<0.001).History of hypertension(34.0%vs25.3%,χ~2= 2.700,p= 0.100),history of coronary heart disease(6.7%vs12.0%,χ~2= 2.521,p=0.112),FBG(8.92±3.02 vs 9.04± 3.38,t =0.327,p=0.744),Hb A1C(9.67 ±1.92 vs 9.20± 2.42,t =-1.883,p=0.061),were no-t statistically significant.2.Compared with the group without plaque(n=241),the group with plaque(n=59)had a longer course of diabetes(15.83 ±6.29vs11.02±6.96,t=4.845,p<0.001),higher CIMT(1.21±0.27vs0.72±0.18,t=17.084,p<0.001),higher RI 0.85±0.07vs0.69 ±0.07,t=15.589,p<0.001),higher age(67.17±8.51vs60.33±9.70,t=4.982,p<0.001),higher HOMAIR(5.08±1.83vs4.29±2.33,t=2.429,p=0.016),more history of hypertension(49.2%vs24.9%,χ~2=13.365,p<0.001),more history of stroke(50.8% vs 1.7%,χ~2=114.115,p<0.001),more history of hyperlipidemia(89.8%vs1.2%,χ~2=244.985,p<0.001),lower BMD of L1-L4(1.036±0.113vs1.137±0.177,t =-4.181,p<0.001),lower BMD of the whole hip(0.833±0.108 vs0.921±0.135,t=-4.650,p<0.001)and lower BMD of the femoral neck(0.782±0.095vs0.860±0.155,t=-3.712,p<0.001);BMI(23.76±2.71vs23.17±3.03,t=-1.453,p=0.147),FBG(8.94±3.27vs9.13±2.93,t=0.400,p=0.690),Hb A1c(9.46±2.22vs9.34±2.09,t=-0.368,p=0.713),history of coronary heart disease(11.9%vs8.7%,χ~2=0.556,p=0.456),smoking history(42.4%vs36.5%,χ~2=0.693,p=0.405)and drinking history(22.0%vs21.6%,χ~2=0.006,p=0.939)were no significant difference.3.The BMD of L1-L4 was negatively correlated with age(r=-0.129,p=0.026),HOMAIR(r=-0.118,p=0.041),CIMT(r=-0.365,p<0.001)and RI(r=-0.178,p=0.002),but positively correlated with BMI(r=0.124,p=0.032),and having no statistical significance with the course of diabetes,FBG and HbA1c.The BMD of femoral neck was negatively correlated with course of diabetes(r=-0.241,p<0.001),age(r=-0.231,p<0.001),HOMAIR(r=-0.195,p=0.001),CIMT(r=-0.317,p<0.001)and RI(r=-0.251,p=0.002),having no statistical significance with BMI,FBG and HbA1c.The BMD of total hip was negatively correlated with the course of diabetes(r=-0.240,p<0.001),age(r=-0.183,p=0.001),HOMAIR(r=-0.131,p=0.024),CIMT(r=-0.391,p<0.001)and RI(r=-0.290,p=0.002),positively correlating with BMI(r=0.130,p=0.025),having no statistical significance with the course of diabetes,FBG and HbA1c.4.Taking osteoporosis and bone mass loss as dependent variables,the course of diabetes,BMI,age,CIMT,RI,HOMAIR and history of stroke,smoking history,drinking history,and history of hyperlipidemia as independent variables,the Binary logistics regression analysis showed that BMI and male were the main protective factors for bone mass loss and osteoporosis in T2DM patients,while smoking history,CIMT,HOMAIR value,RI value and female were the main risk factors for bone mass loss and osteoporosis in T2DM patients.Using CIMT,HOMAIR and RI values as detection variables,osteoporosis and bone loss as outcome variables,ROC curve analysis showed that for CIMT(AUC=0.757,p<0.001),sensitivity was 54%,specificity was 92%,and Youden index was 0.46.For HOMAIR(AUC=0.649,p<0.001),sensitivity 85%,specificity 43%,and Youden index 0.28.For RI value(AUC=0.718,p<0.001),sensitivity53%,specificity 90%,and Youden index 0.43.Conclusion1.In patients with T2DM,those with higher BMI and male patients have lower risk of developing low bone mass,while those with smoking history,high CIMT,high HOMAIR value,high RI value and female patients have higher risk of developing low bone mass.2.Increased CIMT,HOMAIR and RI values can be used as risk factors to predict the risk of low bone mass in T2DM patients.It suggests that patients with atherosclerosis and high insulin resistance should be alert to the occurrence of low bone mass.