Räkel A, Sheehy O, Rahme E, LeLorier J
Research Group in Pharmacoepidemiology and Pharmacoeconomics, Research Centre, centre hospitalier de l'université de Montréal, Hôtel-Dieu, 3850, rue St-Urbain, H2W 1T7, Montréal, Québec, Canada.
Diabetes Metab. 2008 Jun;34(3):193-205. doi: 10.1016/j.diabet.2007.10.008. Epub 2008 Mar 4.
Both diabetes and fractures are prevalent in adults. The relationship between diabetes and osteoporosis is complex and, although it has been investigated extensively, the subject remains controversial. While low bone mineral density (BMD) is consistently observed in type 1 diabetes, the relationship is less clear in type 2 diabetes, with some studies reporting modestly increased or unchanged BMD. Both type 1 and type 2 diabetes have been associated with a higher risk of fractures. Despite discrepancies between BMD and fracture rates, clinical trials uniformly support the fact that new bone formation and bone microarchitecture and, thus, bone quality, are altered in both types of diabetes. Although a causal association between diabetes and osteoporosis cannot be established on the basis of existing data, it is possible to conclude from many studies and from a better understanding of the physiopathology of diabetes that it can increase the risk of fractures through skeletal (decreased BMD and bone quality) and extraskeletal (increased risk of falls) factors. Even though osteoporosis screening or prophylactic treatment in all patients with type 1 and type 2 diabetes is not being recommended at present, such patient populations should be given general guidelines regarding calcium and vitamin D intakes, exercise and the avoidance of potential risk factors for osteoporosis. The extent of diagnostic and therapeutic interventions should be based on the individual's risk profile for fractures.
糖尿病和骨折在成年人中都很常见。糖尿病与骨质疏松症之间的关系很复杂，尽管已经进行了广泛研究，但这个问题仍然存在争议。虽然在1型糖尿病患者中始终观察到低骨密度（BMD），但在2型糖尿病中这种关系不太明确，一些研究报告称BMD略有增加或没有变化。1型和2型糖尿病都与较高的骨折风险相关。尽管BMD和骨折发生率之间存在差异，但临床试验一致支持这样一个事实，即两种类型的糖尿病都会改变新骨形成、骨微结构，进而改变骨质量。虽然根据现有数据无法确定糖尿病与骨质疏松症之间存在因果关系，但从许多研究以及对糖尿病生理病理学的更好理解中可以得出结论，糖尿病可通过骨骼因素（降低的BMD和骨质量）和骨骼外因素（增加的跌倒风险）增加骨折风险。尽管目前不建议对所有1型和2型糖尿病患者进行骨质疏松症筛查或预防性治疗，但应该为这类患者群体提供关于钙和维生素D摄入量、运动以及避免骨质疏松症潜在危险因素的一般指导方针。诊断和治疗干预的程度应基于个体的骨折风险状况。
