The Changed BMD Of Diabetic Nephropathy Patients With Osteoporosis After Treatment

Objective: With the development of people's life quality and the extendibility of natural life, the morbidity of the diabetic mellitus and the osteoporosis is increasing. Diabetes mellitus is one of metabolic diseases with many complications which was leaded by absence of insulin or (and) disorder of biology founction, diabetic osteoporosis is one of complications. It can lead to less bone mass, less bone material density or osteoporosis, even bone fracture no matter type 1 or type 2 diabetes mellitus, so morbidity of bone fraction leaded by diabetic osteoporosis is rising. It was because absence of insulin or/and disorder of biology founction which can lead to diabetic mellitus That Bone metabolism can be affected by different ways resulted from diabetes and the correlated metabolic disorders leads to the outcome of metabolic bone disease. Recent studies have demonstrated that an elevated risk of osteoporosis and fractures happen in diabetic subjects. The presence osteoporosis in type 1diabetes seems to be reliable evidence. On the other hand, there is still some controversy about the risk of osteoporosis in typ2 diabetes. Although the pathogenic mechanisms are not fully understood, diabetic nephropathy is considered as an important factor leading to the bone loss in diabetes. There is great connection between kidney and bone metabolism, 1,25(OH)2D3,can be composed and excreted by kidney, and the reabsorption of calcium and phosphorus is regulated by renal tubule ,With the kidney being damaged, nephron with function is reduced and 1,25(OH)2D3 is decreased , leading to the imbalance of calcium. With the function of kidney is being much more damaged , phosphorus can't be released and blood phosphorus rises, the secondary hyperparathyroidism and hypoparathyroidismrenal osteodystrophy were resulted from the decrease of blood calcium. It can be behaved as osteoporosis osteomalacia,osteitis fibrosa or bone sclerosis . In this study ,we evaluate the BMD of diabetic patients and diabetic Nephropathy patients and analyze the changed BMD of diabetic nephropathy patients with osteoporosis after treatment to investigate the therapy effect of calcium and active vitamin D to the diabetic nephropathy with osteoporosis patients, in order to provide guideline for precaution and treatment them.Methods: In this study,86 object subjects (43 men and 43 women) with type 2 diabetes mellitus (defined by 1999 WHO criteria), It was divided to three groups by UAE ,they are diabetic group(DM,UAE<30mg/d, 12 men and 12 women),earlier diabetic nephropathy group(DN1,30mg/d≤UAE≤300mg/d, 16 men and 16 women) and clinical diabetic nephropathy group (DN2,UAE>300mg/d, 15 men and 15 women).All subjects were evaluated for BMD at L(2)~L(4) lumbar vertebrae and at the femur (neck, trochanter, InterTro and total) by DEXA (dual energy X-ray absorptiometry). Diabetic duration, FBG, PBG were recorded, and these data were evaluated for any relationship in respect to BMD measurements. According to the BMD , diabetic nephropathy with osteoporosis patients were divided in two groups by random,they are group Caltrate,group Caltrate and Rocatorl,BMD and other markers were detected and analized.Characteristics of subject obtained:①BMD were measured by OSTEOCORE 3 made in MEDI LINK (France)②hemoglobinA1c in blood were determined by DCA2000+(BayerCo.Germany).③fasting plasma insulin(FINS), were measured with radioimmunoassay.Results1 There are positive correlations between BMD with, FINS, 2hPINS and GFR, negative correlations with the diabetic duration ,HbA1c and UAE.2 The clinical data of three groups were compared, the BMD of diabetic patients of lumber vertebrae and femur were lower than the diabetic nephropathy patient's,and the diabetic patients with clinical nephropathy were higher. (P<0.05)3 The BMD of diabetic nephropathy patients with osteoporosis were risen after treatment with Caltrate and Rocatorl,the group of Caltrate and Rocatorl were significant (P<0.05). Conclusion1 The high risk of osteoporosis in type 2 diabetic patients is related to absence of insulin, poor glycemic control, higher UAE, lower GFR and long course of the disease.2 The diabetic patients with clinical nephropathy are easier to be developed the osteoporosis.3 The BMD of diabetic patients with clinical nephropathy can be improved by taking calcium and active vitamin D.