Department of Epidemiology and Biostatistics, University of California San Francisco , San Francisco, CA , USA.
Front Endocrinol (Lausanne). 2013 May 30;4:62. doi: 10.3389/fendo.2013.00062. eCollection 2013.
Older women with type 2 diabetes mellitus (DM) have higher bone mineral density (BMD) but also have higher rates of fracture compared to those without DM. Limited evidence suggests that DM may also be associated with more rapid bone loss. To determine if bone loss rates differ by DM status in older women, we analyzed BMD data in the Study of Osteoporotic Fractures (SOF) between 1986 and 1998. SOF participants were women ≥65 years at baseline who were recruited from four regions in the U.S. DM was ascertained by self-report. BMD was measured with dual-energy x-ray absorptiometry (DXA) at baseline and at least one follow-up visit at the hip (N = 6624) and calcaneus (N = 6700) and, on a subset of women, at the spine (N = 396) and distal radius (N = 306). Annualized percent change in BMD was compared by DM status, using random effects models. Of 6,867 women with at least one follow-up DXA scan, 409 had DM at baseline. Mean age was 70.8 (SD 4.7) years. Baseline BMD was higher in women with DM at all measured sites. In models adjusted for age and clinic, women with prevalent DM lost bone more rapidly than those without DM at the femoral neck (-0.96 vs. -0.59%/year, p < 0.001), total hip (-0.98 vs. -0.70%/year, p < 0.001), calcaneus (-1.64 vs. -1.40%/year, p = 0.005), and spine (-0.33 vs. +0.33%/year, p = 0.033), but not at the distal radius (-0.97 vs. -0.90%/year, p = 0.91). These findings suggest that despite higher baseline BMD, older women with DM experience more rapid bone loss than those without DM at the hip, spine, and calcaneus, but not the radius. Higher rates of bone loss may partially explain higher fracture rates in older women with DM.
患有 2 型糖尿病（DM）的老年女性的骨密度（BMD）更高，但与无 DM 者相比，骨折发生率也更高。有限的证据表明，DM 也可能与更快的骨质流失有关。为了确定在老年女性中，骨丢失率是否因 DM 状态而异，我们分析了 1986 年至 1998 年期间进行的骨质疏松性骨折研究（SOF）中的 BMD 数据。SOF 参与者为基线时年龄≥65 岁的女性，她们来自美国四个地区。DM 通过自我报告确定。基线时和至少一次随访时（髋部[N=6624]和跟骨[N=6700]，并在一部分女性中，脊柱[N=396]和桡骨远端[N=306]）使用双能 X 线吸收法（DXA）测量 BMD。使用随机效应模型比较 DM 状态下的 BMD 年化百分比变化。在至少有一次随访 DXA 扫描的 6867 名女性中，有 409 名基线时有 DM。平均年龄为 70.8（SD 4.7）岁。在所有测量部位，患有 DM 的女性的基线 BMD 更高。在调整年龄和诊所的模型中，与无 DM 者相比，患有现患 DM 的女性在股骨颈（-0.96 比-0.59%/年，p<0.001）、全髋（-0.98 比-0.70%/年，p<0.001）、跟骨（-1.64 比-1.40%/年，p=0.005）和脊柱（-0.33 比+0.33%/年，p=0.033）处的骨质流失速度更快，但在桡骨远端（-0.97 比-0.90%/年，p=0.91）处则不然。这些发现表明，尽管基线 BMD 较高，但与无 DM 者相比，患有 DM 的老年女性在髋部、脊柱和跟骨处的骨质流失速度更快，但在桡骨远端则不然。更高的骨丢失率可能部分解释了患有 DM 的老年女性更高的骨折率。
