| Objective:To explore the correlation between changes in the insulin resistance metabolic score(METS-IR)and bone mineral density at various sites and serum sRANKL,OPG.Methods:The middle-aged and elderly population who had a health check-up in Northern Jiangsu People’s Hospital in May 2021 and a follow-up health check-up in May 2022were selected as the study subjects.General basic data,including age,gender,height,weight,and blood pressure were obtained.Fasting blood glucose(FBG),glycosylated hemoglobin A1c(Hb A1c),albumin(ALB),blood calcium(Ca),triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),uric acid(UA),and others were measured,and METS-IR was computed.Dual-energy X-ray bone densitometry(DXA)was applied to measure the bone density of lumbar vertebra and the left femoral neck;serum sRANKL and OPG were measured by enzyme-linked immunosorbent assay(ELISA).Subjects were divided into METS-IR decrease group(OL group,n=180)and METS-IR increase group(OH group,n=152)by whether the amount of METS-IR change was less than 0.The differences in age,gender,body mass index(BMI),blood pressure,sRANKL,OPG,and changes in bone mineral density at different sites were compared between the two groups,and then the changes in bone mineral density according to gender were stratified analysis;correlation analysis,simple linear and multiple linear regression analysis were performed according to the results of the comparison between groups;the diagnostic value of METS-IR change rate for increased bone density was analyzed using receiver operating characteristic curve(ROC).P<0.05 difference was statistically significant.Results:1.A total of 332 subjects who satisfied the eligibility requirements were chosen for the research,including 180 in the OL group with a mean age of 63.93±9.68 years and a mean BMI of 25.64±2.76 kg/m~2;152 in the OH group with a mean age of 67.50±10.22years and a mean BMI of 23.58±2.56 kg/m~2.2.Compared with the OL group,the OH group had lower baseline weight(64.75±10.5 vs.71.56±11.35,P=0.006),lower baseline BMI(23.58±2.56 vs.25.64±2.76,P=0.001),lower baseline TG(1.23(0.89,1.56)vs.1.62(1.24,2.68,P=0.001));higher baseline HDL-C(1.27(1.12,1.66)vs.1.16(1.02,1.33,P=0.015))and higher follow-up sRANKL(147.47(126.62,176.51)vs.135.69(114.87,153.00),P=0.034).The results of stratified analysis based on gender showed that,in males,compared with the OL group,the change of bone mineral density of the fourth lumbar vertebrae in the OH group was greater(0.021(-0.008,0.060)vs-0.011(-0.034,0.040),P=0.023),the change of bone mineral density of the femoral neck was greater(0.018(-0.017,0.035)vs-0.01(-0.032,0.010),P=0.034),the change rate of bone mineral density of the fourth lumbar vertebrae was greater(1.798(-0.691,5.707)vs-0.679(-2.665,3.135),P=0.017),and the change rate of bone mineral density of the femoral neck was greater(2.226(-1.651,3.074)vs-0.108(-3.181,1.093),P=0.040).There was no significant difference in the change of bone mineral density and the change rate of bone mineral density of each part between the OL group and the OH group of female subjects(P>0.05).3.The results of correlation analysis showed that the change rate of METS-IR was positively correlated with follow-up sRANKL(r=0.242),the change rate of bone mineral density of the fourth lumbar vertebra(r=0.228)and△systolic pressure(r=0.210);it was negatively correlated with baseline body weight(r=-0.307),baseline BMI(r=-0.372)and baseline diastolic blood pressure(r=-0.27),P<0.05.4.Simple linear regression and multiple linear regression with sRANKL as the dependent variable,METS-IR rate of change as the independent variable,and stepwise correction of confounding factors showed that METS-IR rate of changeβ1=0.421,β2=0.406,andβ3=0.404,P<0.05.5.Using stepwise confounding factor correction,simple linear regression and multiple linear regression were conducted in males and females,respectively,with the rate of change of fourth lumbar vertebra bone density as the dependent variable and METS-IR rate of change as the independent variable,and the results showed that in males,METS-IR rate of changeβ1=0.556,β2=0.537,β3=0.494,β4=0.489,P<0.05;in females METS-IR change rate Model4β4=0.345,P<0.05.6.In males and females,stepwise confounding factor correction was used in simple linear regression and multiple linear regression with the rate of change of fourth lumbar vertebra bone mineral density as the dependent variable and sRANKL as the independent variable.The findings revealed that:sRANKL in males Model3β3=0.232,Model4β4=0.157,P<0.05;sRANKL in females Model1β1=0.720,Model4β4=0.138,P<0.05.7.ROC curve analysis of the change rate of METS-IR on the prediction performance of whether the change rate of bone mineral density of the fourth lumbar vertebra of subjects increases:the area under the curve(AUC)of METS-IR change rate to predict the increase of the fourth lumbar vertebra bone mineral density change rate was 0.687(95%CI 0.571-0.803,P=0.004),and the best cut-off point of METS-IR change rate on the prediction of the increase of bone mineral density of the fourth lumbar vertebra was1.89,the sensitivity was 0.596,the specificity was 0.806,and the Jordan index was 0.402.Conclusion:1.The lower baseline weight,BMI,and TG,higher baseline HDL-C and follow-up sRANKL,the greater amount and rate of change in fourth lumbar spine BMD was obtained with increased METS-IR,especially in men.2.METS-IR change rate was positively correlated with follow-up sRANKL,the change rate of bone mineral density of the fourth lumbar vertebra and△systolic pressure;it was negatively correlated with baseline body weight,BMI and diastolic blood pressure.3.METS-IR change rate positively affected sRANKL value significantly,METS-IR change rate in males positively affected the fourth lumbar vertebra BMD change rate significantly,and sRANKL positively affected the fourth lumbar vertebra BMD change rate significantly.4.METS-IR change rate had a certain diagnostic value for increased bone mineral density of the fourth lumbar vertebra. |
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