Rasul Sazan, Ilhan Aysegul, Wagner Ludwig, Luger Anton, Kautzky-Willer Alexandra
Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
Gend Med. 2012 Jun;9(3):187-96. doi: 10.1016/j.genm.2012.03.004. Epub 2012 Apr 12.
There is evidence that diabetic polyneuropathy (PNP) is associated with reduced bone mineral density (BMD) in type 1 diabetes but little is known about the impact of diabetic PNP on bone metabolism in type 2 diabetes.
The aim of this study was to evaluate differences in bone metabolism by measuring markers of bone turnover and BMD in men and postmenopausal women with type 2 diabetes and diabetic PNP compared with those without PNP. Gender differences were analyzed for both groups of patients.
One hundred twenty patients with type 2 diabetes, 68 without PNP (43 men, 25 women, mean age 62 [8] years) and 52 with PNP (28 men, 24 women, mean age 64 [8] years) were studied. Clinical parameters with bone turnover biomarkers such as osteocalcin, bone alkaline phosphatase, procollagen type 1 amino-terminal propeptide, and carboxy-terminal telopeptide of type 1 collagen were measured in all patients. Dual energy x-ray absorptiometry to evaluate BMD was performed in a subgroup of patients.
After controlling for age, body mass index, duration of diabetes, smoking, glycosylated hemoglobin, homeostasis model assessment index for insulin resistance, serum C-reactive protein, creatinine, calcium, gamma-glutamyltransferase, parathyroid and sex hormones levels, presence of micro/macrovascular complications, statin- as well as diabetes-related therapies, levels of carboxy-terminal telopeptide of type 1 collagen and procollagen type 1 amino-terminal propeptide were significantly higher among patients with PNP when compared with patients without PNP (P = 0.01 and P = 0.03, respectively). Differences in bone biomarkers were more pronounced among men with diabetes. BMD did not differ significantly between patients with and without PNP, independent of gender.
Male patients with PNP exhibit a higher rate of bone turnover than men without PNP. High rate of bone turnover increases the susceptibility for developing osteoporosis. Prevention of diabetic PNP might also reduce the incidence of osteoporosis and fractures in patients with type 2 diabetes.
有证据表明，1型糖尿病患者的糖尿病性多发性神经病（PNP）与骨密度（BMD）降低有关，但关于糖尿病性PNP对2型糖尿病患者骨代谢的影响知之甚少。
本研究旨在通过测量2型糖尿病合并糖尿病性PNP的男性和绝经后女性与无PNP者的骨转换标志物和骨密度，评估骨代谢的差异。对两组患者的性别差异进行了分析。
研究了120例2型糖尿病患者，其中68例无PNP（43例男性，25例女性，平均年龄62[8]岁），52例有PNP（28例男性，24例女性，平均年龄64[8]岁）。对所有患者测量了临床参数以及骨转换生物标志物，如骨钙素、骨碱性磷酸酶、I型前胶原氨基端前肽和I型胶原羧基端肽。对部分患者进行了双能X线吸收法以评估骨密度。
在控制年龄、体重指数、糖尿病病程、吸烟、糖化血红蛋白、胰岛素抵抗的稳态模型评估指数、血清C反应蛋白、肌酐、钙、γ-谷氨酰转移酶、甲状旁腺和性激素水平、微血管/大血管并发症的存在、他汀类药物以及糖尿病相关治疗后，与无PNP的患者相比，有PNP的患者I型胶原羧基端肽和I型前胶原氨基端前肽水平显著更高（分别为P = 0.01和P = 0.03）。糖尿病男性患者的骨生物标志物差异更为明显。有无PNP的患者之间骨密度无显著差异，与性别无关。
患有PNP的男性患者比无PNP的男性表现出更高的骨转换率。高骨转换率增加了患骨质疏松症的易感性。预防糖尿病性PNP也可能降低2型糖尿病患者骨质疏松症和骨折的发生率。
