Department of Medicine, University of Manitoba, Winnipeg, Canada.
J Bone Miner Res. 2012 Nov;27(11):2231-7. doi: 10.1002/jbmr.1759. Epub 2012 Sep 28.
There is a growing body of research showing that diabetes is an independent risk factor for fracture. Type 2 diabetes (T2D), which predominates in older individuals and is increasing globally as a consequence of the obesity epidemic, is associated with normal or even increased dual-energy x-ray absorptiometry (DXA)-derived areal bone mineral density (BMD). Therefore, the paradoxical increase in fracture risk has led to the hypothesis that there are diabetes-associated alterations in material and structural properties. An overly glycated collagen matrix, confounded by a low turnover state, in the setting of subtle cortical abnormalities, may lead to compromised biomechanical competence. In current clinical practice, because BMD is central to fracture prediction, a consequence of this paradox is a lack of suitable methods, including FRAX, to predict fracture risk in older adults with T2D. The option of adding diabetes to the FRAX algorithm is appealing but requires additional data from large population-based cohorts. The need for improved methods for identification of fracture in older adults with T2D is an important priority for osteoporosis research.
越来越多的研究表明，糖尿病是骨折的独立危险因素。2 型糖尿病（T2D）多见于老年人，由于肥胖症的流行，在全球范围内呈上升趋势，其与正常甚至增加的双能 X 射线吸收法（DXA）衍生的面积骨矿物质密度（BMD）有关。因此，骨折风险的这种矛盾增加导致了这样一种假设，即糖尿病与物质和结构特性的改变有关。在皮质细微异常的情况下，糖基化胶原基质过度，再加上低周转率状态，可能导致生物力学能力受损。在当前的临床实践中，由于 BMD 是骨折预测的核心，因此，这种矛盾的结果是缺乏合适的方法，包括 FRAX，来预测 T2D 老年患者的骨折风险。将糖尿病添加到 FRAX 算法中的选择很有吸引力，但需要来自大型基于人群队列的额外数据。对于骨质疏松症研究来说，需要改进方法来识别 T2D 老年患者的骨折，这是一个重要的优先事项。
