Dobnig Harald, Piswanger-Sölkner Jutta Claudia, Roth Martin, Obermayer-Pietsch Barbara, Tiran Andreas, Strele Andrea, Maier Elisabeth, Maritschnegg Peter, Sieberer Christian, Fahrleitner-Pammer Astrid
Department of Internal Medicine, Division of Endocrinology and Nuclear Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria.
J Clin Endocrinol Metab. 2006 Sep;91(9):3355-63. doi: 10.1210/jc.2006-0460. Epub 2006 May 30.
Fractures are a major health burden in elderly institutionalized persons. Type 2 diabetes mellitus (DM) has a high prevalence in nursing home patients and has been associated with positive effects on bone mass in younger, community-dwelling elderly.
The objective of this study was to investigate whether type 2 DM affects bone mass, bone turnover, or prospective fracture rates in frail, elderly women living in nursing homes.
DESIGN, SETTING, AND PARTICIPANTS: This study was a prospective cohort of 583 patients with type 2 DM and 1081 control (CTR) individuals above age 70 recruited from 95 nursing homes in Austria. Patients were enrolled and followed up by mobile study teams.
We performed quantitative bone ultrasound measurements at the calcaneus, radius, and proximal third phalanx, measurements of quadriceps strength, and biochemical parameters of mineral metabolism and bone turnover. Patients were prospectively followed for hip and other nonvertebral fractures over 2 yr.
Patients with type 2 DM had significantly higher age-, weight-, and mobility score-adjusted calcaneal stiffness (P < 0.0001), radial speed of sound (P < 0.005), and phalangeal speed of sound (P < 0.05) measurements when compared with CTRs. Mean serum PTH (-20.7%) and osteocalcin levels (-22.3%) were significantly lower (both P < 0.0001) in patients with treated type 2 DM despite comparable low serum 25-hydroxyvitamin D levels and slightly higher adjusted total serum calcium levels compared with CTRs. Important independent determinants of bone turnover in both patient groups were PTH, creatinine clearance, alanine aminotransferase, as well as glycosylated hemoglobin levels, together accounting for 30-40% of its variance. A total of 110 hip fractures occurred during the observation period, corresponding to a hip fracture rate of 3.1% (in CTRs) and 3.4% (in type 2 DM) per 100 patient years; this was not significantly different for CTRs and diabetics.
Decreased PTH levels and higher levels of glycemia independently contribute to lower bone turnover in elderly nursing home patients with type 2 DM. Despite higher bone mass and lower bone turnover, hip fracture risk is comparable with women without DM.
骨折是老年住院患者的主要健康负担。2型糖尿病（DM）在养老院患者中患病率很高，并且已被证明对年龄较轻、居住在社区的老年人的骨量有积极影响。
本研究的目的是调查2型糖尿病是否会影响住在养老院的体弱老年女性的骨量、骨转换或未来骨折发生率。
设计、地点和参与者：本研究是一项前瞻性队列研究，从奥地利的95家养老院招募了583名2型糖尿病患者和1081名70岁以上的对照（CTR）个体。患者由流动研究团队招募并随访。
我们在跟骨、桡骨和近端第三指骨进行了定量骨超声测量，测量了股四头肌力量，以及矿物质代谢和骨转换的生化参数。对患者进行了为期2年的前瞻性随访，观察髋部和其他非椎体骨折情况。
与对照组相比，2型糖尿病患者在年龄、体重和活动评分调整后的跟骨硬度（P < 0.0001）、桡骨声速（P < 0.005）和指骨声速（P < 0.05）测量值显著更高。尽管2型糖尿病患者的血清25-羟维生素D水平较低，且调整后的总血清钙水平略高于对照组，但接受治疗的2型糖尿病患者的平均血清甲状旁腺激素（-20.7%）和骨钙素水平（-22.3%）显著更低（均P < 0.0001）。两组患者骨转换的重要独立决定因素是甲状旁腺激素、肌酐清除率、丙氨酸转氨酶以及糖化血红蛋白水平，这些因素共同解释了其30-40%的变异性。在观察期内共发生110例髋部骨折，对应于每100患者年3.1%（对照组）和3.4%（2型糖尿病患者）的髋部骨折发生率；对照组和糖尿病患者之间无显著差异。
甲状旁腺激素水平降低和血糖水平升高独立导致老年养老院2型糖尿病患者的骨转换降低。尽管骨量较高且骨转换较低，但髋部骨折风险与非糖尿病女性相当。
