| Background&ObjectiveType 2 diabetes mellitus(T2DM)patients are usually complicated with coronary artery calcification and osteoporosis.Studies have shown that coronary artery calcium score(CACs)is correlated with changes of bone mineral density(BMD),but the conclusions are not consistent.The purpose of this study is to analyze the correlation between CACs and BMD of lumbar spine,femoral neck and total body in T2DM patients with different visceral fat area,so as to explore whether CACs can be a predictor for early diagnosis of osteoporosis in T2DM,providing evidence for early detection of T2DM complicated with osteoporosis.MethodsThe clinical data of T2DM patients hospitalized in the Department of Endocrinology,The First Hospital of Lanzhou University from October 2020 to October 2022 were collected.According to the inclusion and exclusion criteria,a total of 373 patients were included,containing 196 males and 177 females.Basic information and laboratory indicators of patients were recorded in detail.Visceral fat area(VFA)was measured by bioelectrical impedance analysis.Agatston method was used to calculate CACs,evaluating the degree of coronary artery calcification quantitatively.BMD of lumbar spine,femoral neck and total body were measured by dual energy X-ray absorptiometry(DXA).According to the diagnostic criteria of visceral obesity,the subjects were divided into non-visceral obesity group(VFA<100cm~2)and visceral obesity group(VFA≥100cm~2).Basic data,laboratory indicators,CACs,BMD and bone metabolism markers were compared between the non-visceral and visceral obesity groups in males and females,respectively.Then,subgroup analysis was performed according to different bone mass in the two groups and the CACs levels of subgroup were compared.Spearman correlation analysis was used to explore the relationship between CACs and BMD and bone metabolism markers in the two groups.Further,corrected regression model was used to analyze the relationship between CACs and BMD.Receiver operating characteristic curve(ROC)was used to analyze the optimal threshold value of CACs for predicting osteoporosis in T2DM patients.SPSS25.0 was used for statistical analysis of the data.Results1.Baseline clinical data of male and female T2DM patients between the two groupsCompared with the VFA<100cm~2 group,the levels of body weight and TG in the VFA≥100cm~2 group for males increased significantly(P<0.05)while HDL-C decreased significantly(P<0.05).There were no statistically significant differences in age,diabetes course,height,BMI,SBP,DBP,FPG,Hb A1c,LDL-C and TC(P>0.05).For females,there were statistically significant differences in weight,BMI and HDL-C levels(P<0.05),but no statistically significant differences in age,diabetes course,height,SBP,DBP,FPG,Hb A1c,LDL-C,TC and TG between the groups(P>0.05).2.Comparison of CACs levels of male and female T2DM patients between the two groupsCompared with the VFA<100cm~2 group,CACs of male and female T2DM patients in the VFA≥100cm~2 group were significantly increased(P<0.05).3.Comparison of BMD levels of male and female T2DM patients between the two groupsCompared with the VFA<100cm~2 group,femoral neck and total body BMD of male and female T2DM patients in the VFA≥100cm~2 group were significantly decreased(P<0.05).Lumbar spine BMD was decreased,but the differences were not statistically significant(P>0.05).4.Comparison of bone metabolism markers of male and female T2DM patients between the two groupsThere were no significant differences in Ca,P,P1NP,β-CTX,BALP,25(OH)D between VFA<100cm~2 group and VFA≥100cm~2 group for males and females(P>0.05).5.Comparison of CACs levels of male and female T2DM patients with different bone mass among the two groupsIn the VFA<100cm~2group,there were no significant differences in the CACs levels for males and females between the normal,osteopenia and osteoporosis subgroups(P>0.05).In the VFA≥100cm~2group,there were significant differences in the CACs levels for males and females between the normal,osteopenia and osteoporosis subgroups(P<0.05).6.Correlation between CACs and BMD of male and female T2DM patients in the two groupsSpearman correlation analysis showed that there was no significant correlation between CACs and lumbar spine BMD,femoral neck BMD and total body BMD of male and female T2DM patients in the VFA<100cm~2 group(P>0.05).In the VFA≥100cm~2 group,CACs was negatively correlated with lumbar spine BMD,femoral neck BMD,and total body BMD of males and females(P<0.05).7.Correlation between CACs and bone metabolism markers of male and female T2DM patients in the two groupsSpearman correlation analysis showed that CACs was not significantly correlated with Ca,P,PINP,β-CTX,BALP,25(OH)D of male and female T2DM patients in the VFA<100cm~2 group(P>0.05).In the VFA≥100cm~2 group,CACs was correlated with BALP and 25(OH)D of males(P<0.05),but not significantly correlated with Ca,P,P1NP,β-CTX(P>0.05).There was no significant correlation between CACs and Ca,P,P1NP,β-CTX,BALP,25(OH)D of females in the VFA≥100cm~2 group(P>0.05).8.Model regression analysis of CACs and BMD in male and female T2DM patients with VFA≥100cm~2After adjusting for multiple influencing factors(Model 3),CACs of male T2DM patients was significantly negatively correlated with lumbar spine BMD,femoral neck BMD and total body BMD(respectivelyβ=-0.098,P=0.002β=-0.137,P=0.004β=-0.111,P=0.005).For females,CACs was significantly negatively correlated with lumbar spine BMD and total body BMD(respectivelyβ=-0.120,P=0.025β=-0.143,P=0.036),and was weakly correlated with femoral neck BMD(β=-0.156,P=0.042).9.ROC curve analysis of AUC and optimal cut-off value of CACsAfter ROC curve analysis,the area under the curve(AUC)of CACs screening osteoporosis in T2DM patients complicated with visceral obesity was 0.772(95%CI:0.688-0.857,P<0.001).The corresponding optimal cut-off value of CACs was 251.85,and the sensitivity was 67.2%,the specificity was 88.3%.ConclusionThe association between CACs and BMD in T2DM patients is different due to differences in abdominal visceral fat area.Assessing visceral fat accumulation is critical to explore the complex relationship between coronary artery calcification and BMD.CACs in T2DM patients with VFA≥100cm~2 was negatively correlated with lumbar spine BMD,femoral neck BMD,and total body BMD.CACs is an independent risk factor for decreased BMD in T2DM patients with visceral obesity.Therefore,CACs may be a predictor of BMD changes and have a certain clinical value in predicting the osteoporosis in T2DM complicated with visceral obesity. |
PDF Full Text Request