| Objective:①To investigate effects of intensive blood glucose control on bone mineral density by DEXA and QCT dynamic, and to determine the impact of intensive blood glucose control on bone strength in elderly patients with type 2 diabetes through bone turnover rate;②To explore the clinical application of QCT, DEXA and bone turnover rate in the diagnosis of osteoporosis and prediction of osteoporotic fractures.Method:Ninety-seven elderly patients with type 2 diabetes were randomly divided into standard group and intensive treatment group. The intensive treatment group had a check of fingertip blood glucose every 2 weeks, and a clinic follow-up every month. The standard group received non-mandatory blood glucose monitoring at home, and one outpatient follow-up quarterly. After five years of treatment, the two groups had a return visit every 3 months and 6 months respectively. The information of BMI, FBS, GHB, hepatic and renal function, blood lipid, 1 hour A / C, EKG, ocular fundus examinations, and adverse events such as hypoglycemia and fracture was collected. BMD of lumbar spine L2-L4 and proximal femur (femoral neck, Ward's triangle, greater trochanter) sites was measured by DEXA before treatment and after three years of treatment and 7 years of treatment. BMD of lumbar spine L1-L3 was measured by QCT after 7 years of treatment. Serum bone alkaline phosphatase (BALP) and tartrate-resistant acid phosphatase-5b (TRAP-5b) was also measured by immunoassay after 3 years and 7 years of treatment. Twenty-one healthy adults of the same age were selected as control group (without DM). Biochemical measurements, including FBS, TG, CH, HDL, LDL, hepatic and renal function, serum BALP, TRAP-5b and BMD of lumbar vertebra were collected. All diabetic patients were divided into fracture group and non-fracture group according to their fracture experience.Result:①Both GHB and FBS were decreased in all elderly patients with type 2 diabetes after the treatment. The measurements of intensive group were lower than those of the standard group, and the difference was significant (P<0.05). In addition, severe hypoglycemia events in intensive treatment group were 3.25 times as many as those in the standard group.②The BMD of lumbar spine (DEXA,QCT)showed no significant difference between elderly patients with type 2 diabetes and the healthy peer(sP>0.05). There was also no significant difference between the two experimental groups(P>0.05). BMD of lumbar spine declined in both groups after three years of treatment (P<0.05), and the values(DEXA) were even lower after 7 years of treatment but the decline was not significant (P>0.05). The difference was also not significant between the two groups (P> 0.05).③BALP of the intensive treatment group was lower than that of the control group, and the difference was significant (P=0.042). But there was no significant difference between the intensive treatment group and the standard group(P>0.05)in this respect. TRAP-5b of both the standard group and the intensive treatment group was higher than that of the normal group, and the difference was significant (P<0.05). TRAP-5b of the female in the normal group was higher than that of the female in the intensive group(p=0.038). BALP and TRAP-5b declined significantly with the increase of age in both the intensive treatment group and the standard group (P<0.05).④Stepwise multiple regression analysis showed that the BMD of haunch bone was correlated with BMI significantly (P<0.05),but insignificantly with FBS and GHB (P>0.05) in three groups. Concerning the correlation between BMD and serum lipid levels, both TC and HDL were positively correlated with lumbar BMD (with r = 0.569, p = 0.007 and r = 0.398, p = 0.031 respectively), and no relation was found with other parts of the BMD. LDL-C and lumbar spine BMD were negatively correlated (r =- 0.328, p = 0.047), had no correlation was detected between LDL-C and the BMD of other parts.⑤There were six cases of non-violent fracture in the intensive treatment group and nine cases in the standard group, eight of whom were female and seven male. Lumbar spine and haunch bone DEXA showed no significant differences in diabetic fracture group, non-fracture group and control group. The QCT was the lowest in the fracture group, and there was significant difference (p <0.05) when compared with non-fracture group. The QCT values in the control group were higher than the fracture group, but showed no significant difference (P> 0.05). BALP of the fracture group, the non-fracture group and the normal group showed no significant difference (P> 0.05). TRAP-5b of both the fracture group and the non-fracture group was significantly higher compared with that of the normal group (p <0.05), while there was no significant difference between the fracture group and the non-fracture group (P> 0.05).Conclusion:①Lumbar spine BMD of elderly patients with type 2 diabetes declined with the increase of their age, but showed no significant difference with that of the normal people of the same age. No correlation was detected between their BMD and FBS, and intensive blood glucose control had little influence on lumbar spine BMD. Control in GHB and FBS may influence the bone strength through their effects on the bone mass.②Serum LDL was the risky factor in osteoporosis while the BMI was the protective factor.③BMD (QCT) dropped significantly in the fracture group of elderly patients with type 2 diabetes, which means that QCT has a promising prospect in clinical application to predict fracture. But BMD (DEXA) and bone metabolism has no obvious significance.④Bone metabolism in patients with type 2 diabetes is characterized by increased bone resorption. Intensive treatment reduced the catabolism of bone, which helped to improve bone mineral density.
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