Predictive Study Of Osteoporosis In Postmenopausal Women With Type 2 Diabetese Mellituse

BackgroundDiabetes(DM)has become an important chronic non-communicable disease in China.In 2010,the prevalence of diabetes in Chinese adult women was 11.0%(10.7%-11.4%).Diabetes can cause a variety of acute and chronic complications,but diabetic osteopathy is easy to be overlooked,which osteoporosis is considered to be the most important metabolic bone disease in diabetic patients.With the intensification of aging,osteoporosis between postmenopausal women has become a public health problem,but postmenopausal women with type 2 diabetes(T2DM)owned multiple risk factors for osteoporosis,and they are high risk population of osteoporosis.The prevalence of osteoporosis in women with type 2 diabetes in China is as high as 32.7%-76.7%in the population of 70-80 years old.The most serious consequence of osteoporosis is fracture,the mortality and morbidity of fracture is higher,especially in the hip and spine.Postmenopausal women,whether with T1DM or T2DM,had a higher risk of hip fractures than healthy controls.Osteoporosis is associated with a variety of factors including age,weight,menstrual history and so on.The increased risk of osteoporosis in patients with T1DM may be associated with a decrease in bone mass caused by the metabolic disorders of protein synthesis and the loss of multiple minerals.There are many studies on the risk factors of osteoporosis in T2DM,but some factors are still controversial in the prevention of osteoporosis in postmenopausal women with type 2 diabetes mellitus.Therefore,it is necessary to study the factors systematically related to the occurrence of osteoporosis in postmenopausal women with T2DM,so as to prevent and treat osteoporosis as well as the decrease of fractures.ObjectiveThe objective of the study is to explore the factors of osteoporosis in postmenopausal women with T2DM and to establish a model which can predict and prevent osteoporosis in postmenopausal women with T2DM.Subjects and MethodsA total of 234 patients with postmenopausal women with T2DM were enrolled in this study from 1 October 2014 to 31 December 2016.The patients were divided into two groups:? osteoporosis group(OP group)159 cases;? bone normal group(NBM group)75 cases.Eliminate patients with tumors,orthopedic diseases and disorders that affect bone health.Bone mineral density(BMD)values in the lumbar spine one to four and hip included femoral neck,trochanter,Ward triangle and full hip were measured by dual X-ray absorptiometry(DXA).And various clinical data were collected at the same time,including age,duration of diabetes,the history of smoking and drinking,menstrual history,the history of marriage and birth,education level,long-term residence,whether single or solitary,medical conditions of residence,whether pay attention to calcium,whether there were chronic complications of diabetes mellitus,whether combined with metabolic syndrome,and measuring height,weight,waist circumference,hip circumference,and pressure,then calculating BMI and waist-to-hip ratio.All data were analyzed by SPSS22.0 statistical software.First of all,each collected factor was analyzed by a single factor analysis to determine whether there was a significant difference on osteoporosis between each group in the OP group and the NBM group.For the numerical variables,the homogeneity of variance test is used.If the variance of the two sets of samples is not uniform,the nonparametric test method is used further,whereas the two independent sample T test is used.For the categorical variables,the contingency table analysis and the chi-square test were applied.In the course of the test,if there is significant difference between the two groups of data,it indicates that the independent variables have significant differences in the dependent variable.In the process of univariate analysis,in order to incorporate more variables for the next multivariate analysis of variance,the significance level was set at 0.10 and combined with clinical practical experience.The results showed that the factors that might influence the osteoporosis of postmenopausal women with type 2 diabetes mellitus.According to the clinical experience body mass index(BMI)is also an important factor affecting osteoporosis in type 2 diabetes mellitus,as a result,multivariate analysis was performed with statistically significant variables,including BMI;through binary logistic regression and variable screening,the main factors influencing osteoporosis were obtained,and the clinical significance binary logistic regression equation was received.ResultsThe independent sample T test showed that the age,duration of diabetes,years of menopause,fasting blood glucose of the osteoporosis group(OP group)and the normal group(NBM group)two groups were statistically significant differences.Through the contingency table analysis and chi square test,it was found that the proportion of OP group was higher than that of NBM group,such as low education level,calcium intake,combining with peripheral vascular disease,diabetic nephropathy and cardiovascular disease.Combined with clinical experience,the statistically significant variables,including BMI,were included into the binary logistic regression analysis to determine that the independent risk factors for osteoporosis in postmenopausal women with type 2 diabetes were age(OR= 1.126;95%CI:1.006-1.260)and the menopausal period(OR= 1.123;95%CI:1.009-1.250),and the independent protective factors were BMI(OR= 0.880;95%CI:0.799-0.968),then the optimal model was obtained at last:Logit(P)=-3.592+0.119(Age)+0.116(Years of menopause)-0.128(BMI)-2.218(Education level)-0.822(Diabetic nephropathy)+0.410(Peripheral vascular disease)-0.094(Cardiovascular disease).Conclusion1.Postmenopausal women with type 2 diabetes mellitus are high risk groups for osteoporosis,with older age,longer years of menopausal and smaller BMI levels in the osteoporosis group.2.Age,years of menopausal,educational level,calcium intake,fasting blood glucose level,duration of diabetes mellitus,peripheral vascular disease and cardiovascular disease are related with the occurrence of osteoporosis in postmenopausal women with type 2 diabetes,which age and years of menopausal are independent risk factors,while BMI is an independent protection factor.3.A predictive model for postmenopausal women with type 2 diabetes mellitus with osteoporosis is Logit(P)=-3.592+0.119(Age)+0.116(Years of menopause)-0.128(BMI)-2.218(Education level)-0.822(Diabetic nephropathy)+0.410(Peripheral vascular disease)-0.094(Cardiovascular disease).