Dutta Mk, Pakhetra R, Garg Mk
Classified Specialist (Medicine & Endocrinology), Command Hospital (NC), Delhi Cantt. - 10.
Senior Advisor (Medicine & Endocrinology), Command Hospital (EC), Delhi Cantt. - 10.
Med J Armed Forces India. 2012 Jan;68(1):48-52. doi: 10.1016/S0377-1237(11)60120-2. Epub 2012 Jan 18.
The relationship between bone mineral density (BMD) and type 2 diabetes mellitus (T2DM) has been controversial. Recent studies have revealed adverse impact of antidiabetic drugs on BMD in type 2 diabetic patients. However, the influence of various antihyperglycaemic agents on BMD has not been well studied.
A total of 200 patients with T2DM were screened initially for the study. Finally 67 patients (M:34, F:33) who satisfied the requirement of having been on one year of prescribed therapy were included for analysis.
Bone mineral density was lower in diabetic patients as compared to controls (hip 0.962 ± 0.167 g/cm(2) vs 1.013 ± 0.184 g/cm(2), P = 0.05; spine 0.929 ± 0.214 g/cm(2) vs 1.113 ± 0.186 g/cm(2), P < 0.00001). In males BMD was significantly lower at spine (P < 0.00001) and in females BMD was significantly lower in both at the spine (P < 0.00001) and hip (P < 0.032). On multivariate analysis significant positive correlation was found between spine BMD and body mass index (BMI) (r = 0.372, P = 0.002), total cholesterol (r = 0.272, P = 0.026), low-density lipoprotein (r = 0.242, P = 0.047), and triglycerides (r = 0.282, P = 0.021). There was no correlation between BMD and glycosylated haemoglobin (r = 0.158, P = 0.265). A significant decrease in BMD at spine and hip was seen with the use of glitazones and metformin while increase was noted with sulphonylurea and its combination.
Men and women with T2DM have lower BMD. Bone mineral density did not have correlation to glycaemic control. Glitazones, metformin, and insulin are associated with decrease in BMD at spine, and hip, while sulphonylureas are associated with increase in BMD.
骨密度（BMD）与2型糖尿病（T2DM）之间的关系一直存在争议。近期研究揭示了抗糖尿病药物对2型糖尿病患者骨密度的不良影响。然而，各种降糖药物对骨密度的影响尚未得到充分研究。
最初共筛选了200例T2DM患者用于该研究。最终纳入67例（男性34例，女性33例）满足接受一年规定治疗要求的患者进行分析。
与对照组相比，糖尿病患者的骨密度较低（髋部0.962±0.167g/cm²对1.013±0.184g/cm²，P = 0.05；脊柱0.929±0.214g/cm²对1.113±0.186g/cm²，P < 0.00001）。男性脊柱骨密度显著较低（P < 0.00001），女性脊柱和髋部骨密度均显著较低（脊柱P < 0.00001，髋部P < 0.032）。多因素分析发现脊柱骨密度与体重指数（BMI）（r = 0.372，P = 0.002）、总胆固醇（r = 0.272，P = 0.026）、低密度脂蛋白（r = 0.242，P = 0.047）和甘油三酯（r = 0.282，P = 0.021）之间存在显著正相关。骨密度与糖化血红蛋白之间无相关性（r = 0.158，P = 0.265）。使用格列酮类和二甲双胍后，脊柱和髋部骨密度显著降低，而磺脲类及其联合用药则使骨密度升高。
T2DM男性和女性的骨密度较低。骨密度与血糖控制无关。格列酮类、二甲双胍和胰岛素与脊柱和髋部骨密度降低有关，而磺脲类与骨密度升高有关。
