The Influencing Factors For Fracture In Type 2 Diabetic Patients

Objective: To investigate the risk factors of fractures in patients with type 2 diabetes mellitus.Methods: The clinical data of 210 patients with Type 2 diabetes(T2D)who were hospitalized in the Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from January 2015 to December 2022 were collected.According to the presence or absence of fragility fractures,the patients were divided into T2 D fracture group and T2 D non-fracture group.There were 105 cases in the T2 D fracture group and 105 cases in the T2 D non-fracture group.The data of patients included smoking history,drinking history,gender,age,weight,menstrual history(female),fracture history,and fall history.ALP,ALB,Ca,P,FBG,Hb A1 c,FINS,TC,TG,HDL-C,LDL-C,VLDL-C,Scr,25-OHD,PTH,bone metabolism markers,BMD and other indicators were detected.Spearman correlation analysis was used to analyze the correlation between HDL-C,ALP,ALB,BMI,25-OHD and BMD and bone metabolism indexes.Logistic regression analysis was used to analyze the related factors affecting the occurrence of fractures in T2 D.Receiver operating characteristic curve was used to analyze the predictive value of diabetic fractures.P < 0.05 was considered statistically significant.Results:1.The female incidence,age,ALP,HDL-C,PINP,and phosphorus in T2 D fracture group were higher than those in T2 D non-fracture group.However,the BMI,UA,25-OHD,PTH,γ-GT,ALB,L4 BMD,femoral neck BMD,and radius BMD in T2 D fracture group were lower than those in T2 D non-fracture group(all P < 0.05).2.BMI was positively correlated with L4 BMD T score and femoral neck BMD T score;HDL-C was negatively correlated with β-CTX.ALP was positively correlated with BGP,PINP and β-CTX,and negatively correlated with L4 BMD and femoral neck BMD.ALB was negatively correlated with β-CTX,and positively correlated with radial BMD and femoral neck BMD(all P < 0.05).There was no correlation between 25-OHD and BMD or bone metabolism markers.3.In T2 D patients,the influencing factors of fracture occurrence included BMI,PTH,25-OHD,Hb A1 c,duration of diabetes,HDL-C,UA,ALP,phosphorus,ALB,radius BMD,L4 BMD,femoral neck BMD(all P < 0.05).BMI,PTH,25-OHD,UA,ALB,radial BMD,L4 BMD,and femoral neck BMD were protective factors for T2 D fractures,while Hb A1 c,diabetes duration,HDL-C,ALP,and phosphorus were risk factors for T2 D fractures.4.The ROC curve showed that the cut-off value of ALP for the diagnosis of fractures in T2 D patients was 91.75,with a sensitivity of 56% and a specificity of 71.35%.The of radial BMD was less than-1.15,with a sensitivity of 93.75% and a specificity of64.41%.The of L4 BMD was less than-1.35,with a sensitivity of 78.13% and a specificity of 79.71%.The of femoral neck BMD was <-1.9,with a sensitivity of56.67% and a specificity of 89.71%.Conclusion:1.T2 D fractures are characterized by older age,lower BMI,lower BMD,higher incidence in women,and active bone metabolism.2.BMI,HDL-C,ALP and ALB can affect BMD and bone metabolism in patients with T2 D fractures;3.BMI,PTH,25-OHD,Hb A1 c,duration of diabetes,HDL-C,UA,ALP,phosphorus,ALB,radial BMD,lumbar vertebra BMD,and femoral neck BMD were the influencing factors of T2 D fractures.4.BMI,ALP,UA,HDL-C,radial BMD,lumbar vertebra BMD,and femoral neck BMD had diagnostic value for T2 D fractures.