Yasuda S, Wada S
The Fourth Department of Internal Medicine, Saitama Medical School.
Clin Calcium. 2001 Jul;11(7):879-83.
Diabetes mellitus has been documented to affect bone and calcium metabolism. However, there is conflicting data on the frequency of fractures, changes of bone mineral density and the levels of bone metabolic markers in diabetes. These results may be related to heterogeneity of the patients in the studies, i.e., the presence or absence of insulin injection, body mass index, the amounts of intrinsic insulin secretion and/or insulin resistance. The combination of poor bone quality and frequent injurious falls would be expected to increase fracture incidence and a recent report revealed that older women with diabetes had a particularly increased risk of fractures. The metabolic effects of poor glycemic control lead to increased bone resorption without sufficient bone formation. With respect to bone metabolic markers, decreased levels of osteocalcin (OC) have been commonly reported. It is not known whether decreased OC is a predictive factor for fractures in diabetes, but the osteocalcin levels have been found to return toward the normal range after glycemic control. Since OC is known to be glycosylated, it is also possible that the measurement would be affected by high glucose conditions. The exact value of bone metabolic markers in diabetes has not been established, but measurement of osteocalcin may be a useful tool for evaluation of risk of fractures in diabetic patients.
糖尿病已被证明会影响骨骼和钙代谢。然而，关于糖尿病患者骨折发生率、骨矿物质密度变化以及骨代谢标志物水平的数据存在矛盾。这些结果可能与研究中患者的异质性有关，即是否注射胰岛素、体重指数、内源性胰岛素分泌量和/或胰岛素抵抗情况。骨质不佳与频繁发生的意外伤害性跌倒相结合，预计会增加骨折发生率，最近一份报告显示，老年糖尿病女性骨折风险尤其增加。血糖控制不佳的代谢效应会导致骨吸收增加而没有足够的骨形成。关于骨代谢标志物，通常报告骨钙素（OC）水平降低。尚不清楚OC水平降低是否是糖尿病患者骨折的预测因素，但已发现血糖控制后骨钙素水平会恢复到正常范围。由于已知OC会发生糖基化，测量结果也可能受高血糖状况影响。糖尿病中骨代谢标志物的确切价值尚未确定，但测量骨钙素可能是评估糖尿病患者骨折风险的有用工具。
