Colleluori Georgia, Aguirre Lina, Dorin Richard, Robbins David, Blevins Dean, Barnouin Yoann, Chen Rui, Qualls Clifford, Villareal Dennis T, Armamento-Villareal Reina
Baylor College of Medicine, One Baylor Plaza, 77030 Houston, TX, USA; Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, 77030 Houston, TX, USA; University Campus Biomedico of Rome, Via Alvaro del Portillo, 21 04000100, Rome, Italy.
New Mexico VA Health Care System, 1501 San Pedro SE, 87108 Albuquerque, NM, USA.
Bone. 2017 Jun;99:14-19. doi: 10.1016/j.bone.2017.03.039. Epub 2017 Mar 16.
Both hypogonadism and type 2 diabetes mellitus (T2D) are associated with increased fracture risk. Emerging data support the negative effect of low testosterone on glucose metabolism, however, there is little information on the bone health of hypogonadal men with diabetes. We evaluated the bone mineral density (BMD), bone geometry and bone turnover of hypogonadal men with T2D compared to hypogonadal men without diabetes.
Cross-sectional study, men 40-74years old, with average morning testosterone (done twice) of<300ng/dl. Areal BMD (aBMD) was measured by DXA; volumetric BMD (vBMD) and bone geometry by peripheral-quantitative-computed-tomography; serum C-telopeptide (CTX), osteocalcin, sclerostin and sex hormone-binding globulin (SHBG) by ELISA, testosterone and 25-hydroxyvitamin D (25OHD) by automated immunoassay and estradiol by liquid-chromatography/mass-spectrometry. Groups were compared by ANOVA adjusted for covariates.
One-hundred five men, 49 with and 56 without diabetes were enrolled. Adjusted vBMD at 38% tibia was higher in diabetic than non-diabetic men (857.3±69.0mg/cm vs. 828.7±96.7mg/cm, p=0.02). Endosteal (43.9±5.8mm vs. 47.1±7.8mm, p=0.04) and periosteal (78.4±5.0mm vs. 81.3±6.5mm, p=0.02) circumferences and total area (491.0±61.0mm vs. 527.7±87.2mm, p=0.02) at 38% tibia, were lower in diabetic men even after adjustments for covariates. CTX (0.25±0.14ng/ml vs. 0.40±0.19ng/ml, p<0.001) and osteocalcin (4.8±2.8ng/ml vs. 6.8±3.5ng/ml, p=0.006) were lower in diabetic men; there were no differences in sclerostin and 25OHD. Circulating gonadal hormones were comparable between the groups.
Among hypogonadal men, those with T2D have higher BMD, poorer bone geometry and relatively suppressed bone turnover. Studies with larger sample size are needed to verify our findings and possible even greater risk for fractures among hypogonadal diabetic men.
性腺功能减退和2型糖尿病（T2D）均与骨折风险增加相关。新出现的数据支持低睾酮对糖代谢的负面影响，然而，关于糖尿病性腺功能减退男性的骨骼健康信息较少。我们评估了患有T2D的性腺功能减退男性与无糖尿病的性腺功能减退男性的骨矿物质密度（BMD）、骨几何形态和骨转换情况。
横断面研究，纳入40 - 74岁男性，平均晨间睾酮水平（检测两次）<300ng/dl。采用双能X线吸收法（DXA）测量面积骨密度（aBMD）；采用外周定量计算机断层扫描测量体积骨密度（vBMD）和骨几何形态；采用酶联免疫吸附测定法（ELISA）检测血清I型胶原C端肽（CTX）、骨钙素、硬化蛋白和性激素结合球蛋白（SHBG），采用自动免疫分析法检测睾酮和25 - 羟维生素D（25OHD），采用液相色谱/质谱法检测雌二醇。通过协方差分析对各亚组进行比较。
共纳入105名男性，其中49名患有糖尿病，56名无糖尿病。调整协变量后，糖尿病男性在胫骨38%处的校正vBMD高于非糖尿病男性（857.3±69.0mg/cm vs. 828.7±96.7mg/cm，p = 0.02）。糖尿病男性在胫骨38%处内皮质（43.9±5.8mm vs. 47.1±7.8mm，p = 0.04）和骨膜（78.4±5.0mm vs. 81.3±6.5mm，p = 0.02）周长以及总面积（491.0±61.0mm vs. 527.7±87.2mm，p = 0.02）较低，即使在调整协变量后也是如此。糖尿病男性的CTX（0.25±0.14ng/ml vs. 0.40±0.19ng/ml，p<0.001）和骨钙素（4.8±2.8ng/ml vs. 6.8±3.5ng/ml，p = 0.006）较低；硬化蛋白和25OHD无差异。两组间循环性腺激素水平相当。
在性腺功能减退男性中，患有T2D的男性具有较高的BMD、较差的骨几何形态和相对受抑制的骨转换。需要更大样本量的研究来验证我们的发现以及性腺功能减退糖尿病男性可能更高的骨折风险。
