Yamamoto M, Yamaguchi T, Yamauchi M, Kaji H, Sugimoto T
Department of Internal Medicine 1, Shimane University Faculty of Medicine, 89-1, En-ya-cho, Izumo, Shimane, 693-8501, Japan.
Calcif Tissue Int. 2007 Jun;80(6):353-8. doi: 10.1007/s00223-007-9003-7. Epub 2007 Jun 5.
Although the association between diabetes and osteoporosis has been studied, it remains unclear if the pathogenesis of vertebral fractures in patients with type 2 diabetes would be similar to those without diabetes. One hundred and fifty female diabetic patients without apparent proteinuria as well as 716 women without diabetes (control group) were examined by lateral thoracic and lumbar spine radiographs as well as dual-energy X-ray absorptiometry. Vertebral fractures were found in 26 (17.3%) and 158 (22.1%) subjects in the diabetic and control groups, respectively. Diabetic patients had higher absolute and age-matched (Z score) values of lumbar bone mineral density (L-BMD) than controls despite their significantly higher mean age. By receiver operating characteristic (ROC) analysis, the absolute L-BMD values for detecting vertebral fractures were higher and sensitivity and specificity were lower in diabetic patients than controls (0.816 g/cm2 vs. 0.716 g/cm2 and 66.0% vs. 74.8%, respectively). Logistic regression analysis adjusted for age, body weight, and height also showed that L-BMD was not significantly associated with the presence of vertebral fractures in diabetic patients (odds ratio [OR] = 0.61, 95% confidence interval [CI] 0.34-1.09 per standard deviation increase, P = 0.0954), in contrast to the significant association in controls (OR = 0.23, 95% CI 0.16-0.33, P < 0.0001). These results show that L-BMD is not sensitive enough to assess the risk of vertebral fractures in female diabetic patients and suggest that bone fragility not defined by BMD might be related to the risk of vertebral fractures in them.
尽管已经对糖尿病与骨质疏松症之间的关联进行了研究，但2型糖尿病患者椎体骨折的发病机制是否与非糖尿病患者相似仍不清楚。对150例无明显蛋白尿的女性糖尿病患者以及716例非糖尿病女性（对照组）进行了胸部和腰椎侧位X线片以及双能X线吸收法检查。糖尿病组和对照组分别有26例（17.3%）和158例（22.1%）受试者发生椎体骨折。尽管糖尿病患者的平均年龄明显较高，但其腰椎骨密度（L-BMD）的绝对值和年龄匹配值（Z值）均高于对照组。通过受试者工作特征（ROC）分析，糖尿病患者检测椎体骨折的L-BMD绝对值较高，敏感性和特异性低于对照组（分别为0.816 g/cm²对0.716 g/cm²以及66.0%对74.8%）。对年龄、体重和身高进行校正的逻辑回归分析还显示，L-BMD与糖尿病患者椎体骨折的发生无显著关联（优势比[OR]=0.61，每标准差增加的95%置信区间[CI]为0.34 - 1.09，P = 0.0954），而在对照组中存在显著关联（OR = 0.23，95% CI 0.16 - 0.33，P < 0.0001）。这些结果表明，L-BMD不足以敏感地评估女性糖尿病患者椎体骨折的风险，并提示不由骨密度定义的骨脆性可能与她们椎体骨折的风险有关。
