Schwartz Ann V, Sellmeyer Deborah E, Strotmeyer Elsa S, Tylavsky Frances A, Feingold Kenneth R, Resnick Helaine E, Shorr Ronald I, Nevitt Michael C, Black Dennis M, Cauley Jane A, Cummings Steven R, Harris Tamara B
Department of Epidemiology and Biostatistics, University of California, San Francisco, California 94105, USA.
J Bone Miner Res. 2005 Apr;20(4):596-603. doi: 10.1359/JBMR.041219. Epub 2004 Dec 13.
Type 2 diabetes may be associated with elevated fracture risk, but the impact on bone loss is unknown. Analysis of 4-year change in hip BMD data from a cohort of white and black well-functioning men and women 70-79 years of age found that white women with diabetes had more rapid bone loss at the femoral neck than those with normal glucose metabolism.
Type 2 diabetes may be associated with elevated fracture risk in older adults. Although type 2 diabetes is not associated with lower BMD, older diabetic adults have a higher prevalence of other risk factors for fracture, including more frequent falls, functional limitations, and diabetic complications. With this burden of risk factors, loss of BMD could place older adults with diabetes at higher risk of sustaining a fracture.
To determine if bone loss is increased with type 2 diabetes, we analyzed data from the Health, Aging, and Body Composition Study of white and black well-functioning men and women 70-79 years of age. Hip BMD was measured at baseline and 4 years later in 480 (23%) participants with diabetes, 439 with impaired glucose metabolism, and 1172 with normal glucose homeostasis (NG).
Those with diabetes had higher baseline hip BMD and weight, but among white women, had more weight loss over 4 years. White women with diabetes lost more femoral neck and total hip BMD than those with NG in age-adjusted models. After multivariable adjustment, diabetes was associated with greater loss of femoral neck BMD (-0.32%/year; 95% CI: -0.61, -0.02) but not total hip BMD. In men and black women, change in hip BMD was similar for participants with diabetes and NG.
Despite having higher baseline BMD, diabetic white women, but not men or black women, had more rapid bone loss at the femoral neck than those with NG. This increased bone loss may contribute to the higher fracture risk observed in older diabetic women.
2型糖尿病可能与骨折风险升高有关，但对骨质流失的影响尚不清楚。对一组70 - 79岁功能良好的白人和黑人男性及女性的髋部骨密度数据进行的4年变化分析发现，患有糖尿病的白人女性股骨颈处的骨质流失比糖代谢正常者更快。
2型糖尿病可能与老年人骨折风险升高有关。虽然2型糖尿病与较低的骨密度无关，但老年糖尿病患者有更多其他骨折风险因素，包括更频繁的跌倒、功能受限和糖尿病并发症。有这些风险因素负担，骨密度降低可能使老年糖尿病患者骨折风险更高。
为确定2型糖尿病是否会增加骨质流失，我们分析了健康、衰老和身体成分研究中70 - 79岁功能良好的白人和黑人男性及女性的数据。在基线和4年后对480名（23%）糖尿病参与者、439名糖代谢受损者和1172名糖代谢正常者测量了髋部骨密度。
糖尿病患者基线时髋部骨密度和体重较高，但在白人女性中，4年内体重减轻更多。在年龄调整模型中，患有糖尿病的白人女性股骨颈和全髋骨密度损失比糖代谢正常者更多。经过多变量调整后，糖尿病与股骨颈骨密度更大的损失相关（-0.32%/年；95%置信区间：-0.61，-0.02），但与全髋骨密度无关。在男性和黑人女性中，糖尿病参与者和糖代谢正常者的髋部骨密度变化相似。
尽管基线骨密度较高，但患有糖尿病的白人女性，而非男性或黑人女性，股骨颈处的骨质流失比糖代谢正常者更快。这种骨质流失增加可能导致老年糖尿病女性中观察到的较高骨折风险。
