Dennison E M, Syddall H E, Aihie Sayer A, Craighead S, Phillips D I W, Cooper C
MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
Diabetologia. 2004 Nov;47(11):1963-8. doi: 10.1007/s00125-004-1560-y. Epub 2004 Nov 24.
AIMS/HYPOTHESIS: Previous studies have suggested that the high bone density often observed in type 2 diabetic patients may be explained by insulin resistance. We explored this hypothesis in the Hertfordshire Cohort Study.
A total of 465 men and 444 women aged 59 to 71 years and with no prior diagnosis of diabetes attended a clinic where a glucose tolerance test was performed and bone density measured at the femoral neck and lumbar spine. Biochemical markers of bone turnover (serum osteocalcin and urinary mean c-terminal cross-linking telopeptide of type II collagen) were measured in 163 men.
According to WHO criteria, 83 men and 134 women were diagnosed with impaired glucose tolerance and a further 33 men and 32 women were diagnosed as having type 2 diabetes. Bone density was higher in newly diagnosed diabetic subjects, with relationships stronger in women (p<0.001) than men (p<0.05) and attenuated by adjustment for body mass index. In both sexes, we observed positive correlations between the total femur and femoral neck bone mineral density with measures of insulin resistance (r=0.17-0.22), with stronger results observed in women. These relationships did not apply after adjustment for body mass index. Glucose status did not lead to differences in osteocalcin level or c-terminal cross-linking telopeptide of type II collagen levels.
CONCLUSIONS/INTERPRETATION: Our findings suggest that hyperinsulinaemia may affect bone mineral density through indirect effects, e.g. body weight.
目的/假设：先前的研究表明，2型糖尿病患者中经常观察到的高骨密度可能由胰岛素抵抗来解释。我们在赫特福德郡队列研究中探讨了这一假设。
共有465名男性和444名年龄在59至71岁之间且既往无糖尿病诊断的女性参加了一家诊所的检查，在该诊所进行了葡萄糖耐量试验，并测量了股骨颈和腰椎的骨密度。对163名男性测量了骨转换的生化标志物（血清骨钙素和尿II型胶原平均C末端交联端肽）。
根据世界卫生组织标准，83名男性和134名女性被诊断为糖耐量受损，另有33名男性和32名女性被诊断为2型糖尿病。新诊断的糖尿病患者骨密度较高，女性中的相关性（p<0.001）比男性（p<0.05）更强，且经体重指数调整后减弱。在两性中，我们观察到总股骨和股骨颈骨矿物质密度与胰岛素抵抗指标之间呈正相关（r=0.17-0.22），女性中的结果更强。经体重指数调整后，这些关系不再适用。血糖状态并未导致骨钙素水平或II型胶原C末端交联端肽水平出现差异。
结论/解读：我们的研究结果表明，高胰岛素血症可能通过间接影响，如体重，来影响骨矿物质密度。
