2型糖尿病患者胰岛素使用与桡骨远端骨矿物质密度、骨微结构及骨强度之间的关联——马斯特里赫特研究
The association between insulin use and volumetric bone mineral density, bone micro-architecture and bone strength of the distal radius in patients with type 2 diabetes - The Maastricht study.
作者信息
de Waard E A C, Driessen J H M, de Jong J J A, van Geel T A C M, Henry R M A, van Onzenoort H A W, Schram M T, Dagnelie P C, van der Kallen C J, Sep S J S, Stehouwer C D A, Schaper N C, Koster A, Savelberg H H C M, Neef C, Geusens P P M M, de Vries F, van den Bergh J P W
机构信息
Maastricht University, Department of Internal Medicine, Maastricht, The Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht, The Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Maastricht University Medical Center+, Department of Clinical Pharmacy and Toxicology, Maastricht, The Netherlands.
出版信息
Bone. 2017 Aug;101:156-161. doi: 10.1016/j.bone.2017.05.004. Epub 2017 May 6.
Type 2 diabetes mellitus (T2DM) has been associated with an increased risk of fractures, despite normal to increased bone mineral density (BMD). Insulin use is one of the factors linked to this increased fracture risk. However, direct negative effects of insulin on bone quality are not expected since insulin is thought to be anabolic to bone. In this cross-sectional study the association between insulin use and volumetric BMD (vBMD), bone micro-architecture and bone strength of the distal radius, as measured with HR-pQCT, was examined. Data from 50 participants with T2DM of The Maastricht Study (mean age 62±7.5years, 44% women) was used. Participants were classified as insulin user (n=13) or non-insulin user (n=37) based on prescription data. Linear regression analysis was used to estimate the association between current insulin use and HR-pQCT derived parameters. After adjustment for age, sex, body mass index, glycated hemoglobin A1c and T2DM duration, insulin use was associated with lower total vBMD (standardized beta (β):-0.56 (95% CI:-0.89 to -0.24)), trabecular vBMD (β:-0.58 (95% CI:-0.87 to -0.30)), trabecular thickness (β:-0.55 (95% CI:-0.87 to -0.23)), cortical thickness (β:-0.41 (95% CI:-0.74 to -0.08)), log cortical pore volume (β:-0.43 (95% CI:-0.73 to -0.13)), bone stiffness (β:-0.39 (95% CI:-0.62 to -0.17)) and failure load (β:-0.39 (95% CI:-0.60 to -0.17)) when compared to the non-insulin users. Insulin use was not associated with cortical vBMD, trabecular number, trabecular separation, cortical porosity and cortical pore diameter. This study indicates that insulin use is negatively associated with bone density, bone micro-architectural and bone strength parameters. These findings may partly explain the previously observed increased fracture risk in insulin users, although there may be residual confounding by other factors related to disease severity in insulin users.
2型糖尿病（T2DM）与骨折风险增加相关，尽管骨矿物质密度（BMD）正常或升高。使用胰岛素是导致这种骨折风险增加的因素之一。然而，胰岛素对骨质量的直接负面影响并不被预期，因为胰岛素被认为对骨骼具有合成代谢作用。在这项横断面研究中，研究了使用胰岛素与通过高分辨率外周定量计算机断层扫描（HR-pQCT）测量的桡骨远端体积骨密度（vBMD）、骨微结构和骨强度之间的关联。使用了来自马斯特里赫特研究的50名T2DM参与者的数据（平均年龄62±7.5岁，44%为女性）。根据处方数据，参与者被分类为胰岛素使用者（n = 13）或非胰岛素使用者（n = 37）。使用线性回归分析来估计当前胰岛素使用与HR-pQCT衍生参数之间的关联。在调整年龄、性别、体重指数、糖化血红蛋白A1c和T2DM病程后，与非胰岛素使用者相比，使用胰岛素与较低的总vBMD（标准化β（β）：-0.56（95%置信区间：-0.89至-0.24））、小梁vBMD（β：-0.58（95%置信区间：-0.87至-0.30））、小梁厚度（β：-0.55（95%置信区间：-0.87至-0.23））、皮质厚度（β：-0.41（95%置信区间：-0.74至-0.08））、对数皮质孔隙体积（β：-0.43（95%置信区间：-0.73至-0.13））、骨刚度（β：-0.39（95%置信区间：-0.62至-0.17））和破坏载荷（β：-0.39（95%置信区间：-0.60至-0.17））相关。胰岛素使用与皮质vBMD、小梁数量、小梁间距、皮质孔隙率和皮质孔径无关。这项研究表明，胰岛素使用与骨密度、骨微结构和骨强度参数呈负相关。这些发现可能部分解释了先前观察到的胰岛素使用者骨折风险增加的现象，尽管胰岛素使用者中可能存在与疾病严重程度相关的其他因素导致的残余混杂。
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