| ObjectiveThe incidence of osteoporosis（OP）in patients with type 2 diabetes mellitus（T2DM）and nonalcoholic fatty liver disease（NAFLD）is increasing year by year,and some studies suggest that it may be related to changes in insulin-like growth factor-1（IGF-1）levels.In this study,we analyzed the correlation between serum IGF-1 levels and bone mineral density at lumbar spine 2-4,femoral neck,and whole body in T2DM patients with NAFLD,and then explored whether IGF-1 can be used as a predictor of bone mineral density changes in T2DM patients with NAFLD,providing a basis for the early diagnosis and treatment of osteoporosis in clinical T2DM patients with NAFLD.MethodsThe clinical data of T2DM patients hospitalized in the Department of Endocrinology of the First Hospital of Lanzhou University from December 2019 to December 2021 were collected.According to the inclusion and exclusion criteria,a total of 160 T2DM patients were included in this study.The subjects were divided into simple T2DM group and T2DM combined with NAFLD group according to whether they were combined with NAFLD.Basic information such as gender,age,height,weight,and duration of diabetes was recorded for the study population,and body mass index（BMI）was calculated;biochemical parameters such as fasting plasma glucose（FPG）,fasting insulin（FINS）,glycosylated hemoglobin A1c（Hb A1c）,triglycerides（TG）,high density lipoprotein cholesterol（HDL-C）,and low density lipoprotein cholesterol（LDL-C）were measured;Insulin resistance index was calculated;serum insulin-like growth factor-1（IGF-1）,growth hormone（GH）,and insulin-like growth factor binding protein-3（IGFBP-3）levels were measured by ELISA;bone metabolism parameters such as osteocalcin（OC）,25 Hydroxy Vitamin D（25（OH）D）,procollagen I N-terminal propeptide（PINP）,andβ-telopeptide of type I collagen（β-CTX）were measured by electrochemiluminescence;and bone metabolism parameters such as lumbar spine were measured by dual-energy X-ray absorptiometry in the included study population BMD of vertebrae 2-4,femoral neck,and total body.The differences of basic data,biochemical indexes,bone metabolism markers and bone mineral density between the two groups were compared,and the correlation between serum GH,IGF-1,IGFBP-3 and bone metabolism markers,bone mineral density of different sites in T2DM patients with NAFLD was explored by Spearman correlation analysis.Multiple stepwise regression analysis was used to explore the influencing factors of bone mineral density at different sites.SPSS 23.0was used to analyze the data.Results1.Comparison of general and biochemical data between the two groups:Compared with T2DM group,the BMI,FINS,HOMA-IR,TG,AST and ALT in T2DM combined with NAFLD group were significantly increased,while HDL-C was significantly decreased（P<0.05）;There were no significant differences in age,duration of T2DM,sex,height,FPG,Hb A1c,TC,LDL-C,GGT,Crea,Urea,UA,UPRO and MTP between the two groups（P>0.05）.2.The comparison of bone mineral density and bone metabolism indexes between the two groups:（1）Compared with T2DM group,BMD of lumbar vertebra 2-4 and femoral neck decreased in T2DM with NAFLD group,and the difference had statistical significance（P<0.05）;there was no significant difference in total body BMD level between the two groups（P>0.05）;（2）Compared with the T2DM group,the serum Ca level was increased,while the OC and 25（OH）D levels were decreased in the T2DM with NAFLD group,and the differences were statistically significant（P<0.05）;the serum P,ALP,PTH,PINP,andβ-CTX levels were not significantly different between the two groups（P>0.05）.3.The comparison of IGF-1 and related indicators between the two groups:Compared with T2DM group,the serum levels of GH and IGF-1 in T2DM with NAFLD group were significantly lower（P<0.05）,but the serum levels of IGFBP-3were not significantly different between the two groups（P>0.05）.4.The relationship between IGF-1,GH,IGFBP-3 and bone mineral density:Spearman correlation analysis indicated that there were no significant correlations between serum GH levels and lumbar 2-4 BMD,femoral neck BMD,or total body BMD（P>0.05）;there were positive correlations between serum IGF-1levels and lumbar 2-4 BMD and femoral neck BMD（all P<0.05）;and there were no significant correlations between serum IGFBP-3 and lumbar 2-4 BMD,femoral neck BMD,or total body BMD（P>0.05）.5.Correlation analysis between IGF-1,GH,IGFBP-3 and bone metabolism markers:Spearman correlation analysis showed that serum GH levels were positively correlated with OC and 25（OH）D（P<0.05）and negatively correlated withβ-CTX（P<0.05）;serum IGF-1 levels were positively correlated with OC and 25（OH）D,and were statistically significant（P<0.05）;IGFBP-3 was not significantly correlated with each bone metabolism index（P>0.05）.6.The multiple stepwise regression analysis of the factors related to the BMD of different parts in type 2 diabetes mellitus with nonalcoholic fatty liver:Multiple stepwise regression analysis was performed with lumbar spine 2-4,femoral neck,and total body BMD levels as dependent variables and basic information and various laboratory parameters as independent variables,respectively.Results show:（1）Serum IGF-1,ALT,and P were independent factors of lumbar spine 2-4 BMD（P<0.05）,and then multiple linear regression equation could be obtained:lumbar spine 2-4 BMD（g/cm~2）=0.457+0.006×IGF-1（ng/m L）+0.002×ALT（U/L）–0.103×P（mmol/L）;（2）Serum IGF-1,Sex,PINP,Hb A1c,ALT,OC were independent factors o f femoral neck BMD（P<0.05）,and then multiple linear regression equation co-u ld be obtained:femoral neck BMD（g/cm~2）=0.436+0.004×IGF-1（ng/m L）+0.025×Sex–0.003×PINP（ng/m L）–0.009×Hb A1c（%）–0.001×ALT（U/L）+0.002×OC（ng/m L）;（3）Age,weight,ALP,GH,and TC were independent factors for total body BMD（P<0.05）,and then a multiple linear regression equation could be obtained:Total body BMD（g/cm~2）=1.541–0.078×Sex–0.002×ALP（U/L）–0.055×LDL-C（mmol/L）.ConclusionSerum IGF-1 levels were significantly positively correlated with lumbar spine2-4 BMD and femoral neck BMD in T2DM patients with NAFLD,and IGF-1 was an independent factor for lumbar spine 2-4 BMD and femoral neck BMD.Low levels of IGF-1 may be associated with reduced BMD in T2DM patients with NAFLD,and IGF-1 has the potential to be used as a predictor of BMD changes in T2DM patients with NAFLD. |
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