| BackgroundIn recent years,people's dietary pattern gradually shift to high energy with the improving of people's living standards,and with the processing of aging,the incidence of diabetes has gradually increased.The ageing of the population in society also increases the prevalence of osteoporosis(OP),and they both become a global health problem.Type 2 diabetes(T2DM)patients with long-term hyperglycemia can cause microvascular disease,macrovascular disease,peripheral neuropathy and other common complications,but also damage the skeletal system.Bone mineral density(BMD)measurements were performed in patients with T2 DM in different studys,the results of different scholars are not the same.Among them,some studies have shown that BMD in patients with T2 DM is lower than in the same non-diabetic population,and some studies have shown that BMD in patients with T2 DM is not different from non-diabetic patients under the same conditions,and even studies have shown that the BMD in patients with T2 DM was higher than that of non-diabetic patients.But the risk of fracture in T2 DM patients is generally recognized.The increased risk of T2 DM fractures is not directly proportional to the decline in BMD,BMD measurement can not be used as a criterion for assessing bone metabolic status in patients with T2 DM.This study will explore the relationship between T2 DM and osteoporosis and it's effect on bone metabolism by analyzing the biochemical markers of bone turnover in patients with T2 DM combined with osteoporosis.Objective Evaluate the level of biochemical markers of bone metabolism in patients with T2 DM combined with osteoporosis,to provide theoretical basis for the early diagnosis and prevention of osteoporosis in patients with T2 DM.Methods A total of 102 patients(male> 55 years old,women are postmenopausal women)who were hospitalized in the first affiliated hospital of zhengzhou university from may 2016 to September 2016 were enrolled in this study.Among them,52 patients were T2 DM combined with osteoporosis cases,27 males and 25 females were included,the average age is(61.94±8.88)years old;50 cases were primary osteoporosis patients,including 24 males and 26 females,the average age is(64.53±7.76)years old.Record the patient's course and medication,measure height,weight,and calculate the BMI;The BMD of the lumbar L1-4 and the proximal femur(including the neck,the rotor,the inside,the sum)were measured in all patients using the US GE dual energy X-ray absorptiometry.All patients were given elbow venous blood under fasting conditions on the second day after admission.Detect the level of parathyroid hormone(PTH),25(OH)D3,osteocalcin(OC),?-C-terminal telopeptide of type I collagen(?-CTX),aminoterminal prepeptide type?procollagen(PINP),bone alkaline phosphatase(BALP)and the levels of serum electrolytes,Liver and kidney function,blood lipids,fasting blood glucose(FBG)and so on.The levels of Hb A1 c in T2 DM patients with osteoporosis were measured.Results(1)General information(1)There was no significant difference in the sex ratio,age and BMI between the T2 DM group and the OP group(P> 0.05).(2)There was no significant difference in age,BMI in female patients and male patients between the T2 DM group and the OP group(P> 0.05).(3)The treatment in the past six months of T2 DM group patients: 21 cases used metformin preparations,17 cases used insulin preparations,16 cases used sulfonylurea preparations,6 cases used ? glucosidase inhibitors;13 cases used statins and 8 cases without drug treatment.(2)general biochemical(1)The levels of alanine aminotransferase,aspartate aminotransferase,glutathione transpeptidase,alkaline phosphatase,calcium,phosphorus,serum creatinine between T2 DM combined with osteoporosis patients and primary osteoporosis patients has no significant difference(P> 0.05).(2)There was no significant difference in triglyceride,total cholesterol,high density lipoprotein and low density lipoprotein between T2 DM group compared with primary OP group(P> 0.05).(3)The FBG of T2 DM combined with OP group was higher than that of primary OP group,and the difference was statistically significant(P <0.05).(3)bone density results(1)For female patients,the BMD of the proximal femur(both internal and total hip)in T2 DM group was significantly higher than in the primary osteoporosis group(P <0.05),but the BMD of lumbar vertebrae between the two groups has no significant difference(P> 0.05).(2)There was no significant difference in BMD between male patients with T2 DM and primary osteoporosis(P> 0.05)(4)biochemical markers of bone metabolism(1)The levels of OC,PINP,?-CTX,25(OH)D3 and PTH of female patients in T2 DM group were lower than in primary OP group,and the difference was statistically significant(P <0.05).(2)The levels of OC,PINP,?-CTX and 25(OH)D3 of male patients in T2 DM group were significantly lower than those in primary OP group(P <0.05).There was no significant difference in PTH of male patients between T2 DM grouop and primary osteoporosis group(P> 0.05);(3)There was no significant difference in the BALP between the T2 DM group and the OP group(Z =-0.769,P = 0.442).(5)Correlation between biochemical markers of bone turnover and Hb A1 c in T2 groupThere was a negative correlation between OC,PINP,?-CTX and Hb A1 c in T2 DM group.Conclusions:1.Female's BMD of proximal femur in T2 DM group was higher than that in patients with primary OP,and there was no difference between the two groups in female's lumbar vertebrae;The BMD of lumbar spine and proximal femur of male were no difference between the two groups.2.The rate of bone turnover in patients with T2 DM was slower than that in patients with primary osteoporosis.3.High plasma glucose may have an inhibitory effect on bone turnover. |
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