Moseley K F, Chia C W, Simonsick E M, Egan J M, Ferrucci L, Sellmeyer D E
Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA,
Osteoporos Int. 2015 May;26(5):1555-62. doi: 10.1007/s00198-015-3027-z. Epub 2015 Jan 27.
Fracture risk is increased in type 2 diabetes mellitus (T2DM). The effect of pre-diabetes and T2DM on bone macroarchitecture and strength has not been well investigated. In this study, we show that in women only, both pre-diabetes and T2DM are associated with decreased hip bending strength and mineralization which might lead to skeletal weakness.
Older men and women with T2DM are at increased risk for fracture despite normal bone mineral density (BMD). The discordance between bone quantity and skeletal fragility has driven investigation into additional determinants of fracture resistance in T2DM. Additionally, the effect of pre-diabetes on bone strength has not been well described. The aim of this study was to determine differences in bone macroarchitecture and strength, measured by hip geometry, in persons with normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and T2DM.
We performed cross-sectional analyses of older (age >55 years) men (n = 472) and women (n = 473) participating in the Baltimore Longitudinal Study of Aging (BLSA) classified as NGT, IGT, or T2DM based on oral glucose tolerance testing. Bone strength measures included the hip geometry parameters of section modulus (Z), cross-sectional area (CSA), and buckling ratio (BR). Sex-stratified analyses were conducted using adjusted stepwise regression models.
In women, IGT and T2DM were negatively associated with hip geometry parameters including mineralization in cross section (CSA, ß -0.076 and -0.073, respectively; both p < 0.05) and hip bending strength (Z, ß -0.097 and -0.09, respectively; both p < 0.05); conversely, IGT and T2DM were associated with improved compressive strength (BR, ß -0.31 and -0.29, respectively; both p < 0.05). There was no significant association between glycemic status and hip geometry in men.
In women only, both IGT and T2DM were inversely associated with bone macroarchitecture and measures of bone mineralization and bending strength. The same association between worsening glycemic status and bone strength was not observed in men. These data suggest a differential effect of sex on hip geometry with evolving glucose intolerance.
2型糖尿病（T2DM）患者骨折风险增加。糖尿病前期和T2DM对骨骼宏观结构和强度的影响尚未得到充分研究。在本研究中，我们发现仅在女性中，糖尿病前期和T2DM均与髋部弯曲强度和矿化降低有关，这可能导致骨骼脆弱。
尽管骨密度（BMD）正常，但患有T2DM的老年男性和女性骨折风险增加。骨量与骨骼脆性之间的不一致促使人们对T2DM中抗骨折的其他决定因素进行研究。此外，糖尿病前期对骨强度的影响尚未得到充分描述。本研究的目的是确定糖耐量正常（NGT）、糖耐量受损（IGT）和T2DM患者在通过髋部几何形状测量的骨骼宏观结构和强度方面的差异。
我们对参与巴尔的摩纵向衰老研究（BLSA）的年龄较大（年龄>55岁）的男性（n = 472）和女性（n = 473）进行了横断面分析，根据口服葡萄糖耐量试验将其分类为NGT、IGT或T2DM。骨强度测量包括截面模量（Z）、横截面积（CSA）和屈曲比（BR）等髋部几何参数。使用调整后的逐步回归模型进行性别分层分析。
在女性中，IGT和T2DM与髋部几何参数呈负相关，包括截面矿化（CSA，分别为ß -0.076和-0.073；均p < 0.05）和髋部弯曲强度（Z，分别为ß -0.097和-0.09；均p < 0.05）；相反，IGT和T2DM与抗压强度改善有关（BR，分别为ß -0.31和-0.29；均p < 0.05）。男性的血糖状态与髋部几何形状之间无显著关联。
仅在女性中，IGT和T2DM均与骨骼宏观结构以及骨矿化和弯曲强度测量值呈负相关。在男性中未观察到血糖状态恶化与骨强度之间的相同关联。这些数据表明随着葡萄糖耐量异常的发展，性别对髋部几何形状有不同影响。
