Hip Axis Length And Fracture Risk Of Type 2 Diabetes Mellitus: A Case-control Study

[Objective] To observe the changes of hip axis length(HAL)and other hip geometry parameters in patients with type 2 diabetes mellitus(T2DM),and to explore the correlation and influencing factors between them and the risk of hip fracture in T2 DM patients.[Methods] 105 patients with T2 DM were enrolled in the Department of Endocrinology,Affiliated Hospital of Fujian Medical University from April 2016 to February 2017 and105 healthy subjects were randomly selected as the healthy control group at 1: 1 ratio.The hip bone mineral density was measured using a dual energy X-ray absorptiometry(DAX),and the hip geometric analysis provided by the software before the steep hip analysis(AHA).The fracture risk factor data and clinical data of all the subjects were collected and the risk of hip fracture was measured in T2 DM patients and healthy subjects over the next 10 years using the WHO Fracture Risk Assessment Tool(FRAX)-China model.[Results](1)There was no significant difference in sex composition,age,menopause age,Years since menopause,height and creatinine level between T2 DM group and healthy control group(P> 0.05).The weight,body mass index(BMI),white blood cells,percentage of neutrophils,fasting blood glucose and triglyceride in T2 DM group were higher than those in healthy control group,while hemoglobin,total cholesterol and low density lipoprotein cholesterol were lower than those in healthy control group(P <0.05).(2)The wards' BMD of the T2 DM group was 4.5% lower than the healthy control group,and the BMD of the greater trochanter,femur and hip were increased by 2.7%,0.9% and 1.1%respectively,but the difference was not statistically significant(P>0.05).The 10-Year probability of hip fracture(PHF)of T2 DM group was 29.9% higher than healthy control group,the difference was statistically significant(P <0.05).(3)The HAL of T2 DM group was 2.2% higher than healthy control group,while CSA and CSMI were 5.2% and 9.4% lower than healthy control group,the difference was statistically significant(P <0.05).(4)According to the standard that if PHF?3% or not,the T2 DM group was divided into high risk group of hip fracture and low risk group: In addition to the buckling stress ratio,femoral neck cortical thickness and neck shaft angle,the remaining parameters were statistically different,the CSA,CSMI,femoral cortical thickness and femoral neck minimum width of high risk group were smaller than low risk group,while the HAL was longer.(5)The age,years since menopause,the percentage of neutrophils,HAL and PHF were positively correlated,while weight,TH-BMD,CSA,CSMI and PHF were negatively correlated;the percentage of neutrophils and PHF were positively correlated;The age,weight,femoral neck bone mineral density(FN-BMD)and TH-BMD were significantly correlated with CSA and CSMI,and CSA was negatively correlated with years since menopause,P<0.05.(6)Multiple linear stepwise regression analysis: The influencing factors of CSA in patients with T2 DM were weight and the years since menopause,and the main influencing factors of CSMI were weight.Controlling other variables,weight gain of one kilogram of CSA increased by 2.313mm2,CSMI increased by 175.464mm4,years since menopause for each additional unit,CSA reduced by 0.518mm2.[Conclusion] Patients with T2 DM in Fuzhou China showed a hip geometry changes of longer HAL,smaller CSA,CSMI,may be associated with high risk of hip fracture.HAL is the factor of fracture risk independent of weight,age,BMD,considering the correlation of HAL and PHF,if take the HAL into the FRAX model,will benefit the T2 DM patients with hip fracture risk prediction.