Internal Medicine 1, Shimane University Faculty of Medicine, Japan.
Endocr J. 2011;58(8):613-24. doi: 10.1507/endocrj.ej11-0063. Epub 2011 Jul 20.
Osteoporosis and type 2 diabetes mellitus (T2DM) are now prevalent in aging and westernized societies, and adversely affect the health of the elderly people by causing fractures and vascular complications, respectively. Recent experimental and clinical studies show that both disorders are etiologically related to each other through the actions of osteocalcin and adiponectin. Meta-analyses of multiple clinical studies show that hip fracture risk of T2DM patients is increased to 1.4 to 1.7-folds, although BMD of the patients is not diminished. Vertebral fracture risk of T2DM patients is also increased, and BMD is not useful for assessing its risk. These findings suggest that bone fragility in T2DM depends on bone quality deterioration rather than bone mass reduction. Thus, surrogate markers are needed to replace the insensitivity of BMD in assessing fracture risks of T2DM patients. Markers related to advanced glycation end products as well as insulin-like growth factor-I may be such candidates, because these substances were experimentally shown to modulate bone quality in DM. In practice, it is important for physicians to assess fracture risk in T2DM patients by evaluating prior VFs and fracture histories using spine X-ray and interview, respectively, until the usefulness of surrogate markers is established.
骨质疏松症和 2 型糖尿病（T2DM）现在在老龄化和西化社会中普遍存在，分别通过导致骨折和血管并发症对老年人的健康产生不利影响。最近的实验和临床研究表明，这两种疾病通过骨钙素和脂联素的作用在病因上相互关联。多项临床研究的荟萃分析表明，2 型糖尿病患者的髋部骨折风险增加了 1.4 到 1.7 倍，尽管患者的骨密度没有降低。2 型糖尿病患者的椎体骨折风险也增加了，而骨密度对于评估其风险没有用处。这些发现表明，2 型糖尿病患者的骨脆性取决于骨质量恶化而不是骨量减少。因此，需要替代标志物来替代骨密度对 2 型糖尿病患者骨折风险评估的不敏感性。与晚期糖基化终产物以及胰岛素样生长因子-I 相关的标志物可能是这样的候选物，因为这些物质在实验中显示可以调节 DM 中的骨质量。实际上，医生在评估 2 型糖尿病患者的骨折风险时，通过评估脊柱 X 光和访谈分别评估先前的 VFs 和骨折病史非常重要，直到替代标志物的有效性得到确立。
