Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
J Clin Densitom. 2018 Jul-Sep;21(3):347-354. doi: 10.1016/j.jocd.2017.11.003. Epub 2017 Dec 1.
This study aimed to determine the association between areal and volumetric bone mineral density (BMD) with all-cause mortality in patients with type 2 diabetes (T2D). Associations between BMD and all-cause mortality were examined in 576 women and 517 men with T2D in the Diabetes Heart Study. Volumetric BMD in the thoracic and lumbar spine was measured with quantitative computed tomography. Areal BMD (aBMD) in the lumbar spine, total hip, femoral neck, ultradistal radius, mid radius, and whole body was measured using dual X-ray absorptiometry. Association of BMD with all-cause mortality was determined using sequential models, stratified by sex: (1) unadjusted; (2) adjusted for age, race, smoking, alcohol, estrogen use; (3) model 2 plus history of cardiovascular disease, hypertension, and coronary artery calcification; (4) model 3 plus lean mass; and (5) model 3 plus fat mass. At baseline, mean age was 61.2 years for women and 62.7 years for men. At mean 11.0 ± 3.7 years' follow-up, 221 (36.4%) women and 238 (43.6%) men were deceased. In women, BMD at all skeletal sites (except spine aBMD and whole body aBMD) was inversely associated with all-cause mortality in the unadjusted model. These associations remained significant in the mid radius (hazard ratio per standard deviation = 0.79; p = 0.0057) and distal radius (hazard ratio per standard deviation = 0.76; p = 0.0056) after adjusting for all covariates, including lean mass. In men, volumetric BMD measurements but not aBMD were inversely associated with mortality and only in the unadjusted model. In this longitudinal study, lower baseline aBMD in the radius was associated with increased all-cause mortality in women with T2D, but not men, independent of other risk factors for death.
本研究旨在确定 2 型糖尿病（T2D）患者的骨矿物质密度（BMD）的面积和体积与全因死亡率之间的关系。在糖尿病心脏研究中，对 576 名女性和 517 名男性 T2D 患者的 BMD 与全因死亡率之间的关系进行了检查。使用定量计算机断层扫描测量胸腰椎的体积 BMD。使用双能 X 线吸收法测量腰椎、全髋、股骨颈、桡骨远段、桡骨中段和全身的面积 BMD（aBMD）。通过序贯模型确定 BMD 与全因死亡率之间的关系，按性别分层：（1）未调整；（2）调整年龄、种族、吸烟、饮酒、雌激素使用；（3）模型 2 加心血管疾病、高血压和冠状动脉钙化史；（4）模型 3 加瘦体重；（5）模型 3 加脂肪量。在基线时，女性的平均年龄为 61.2 岁，男性为 62.7 岁。在平均 11.0±3.7 年的随访中，221 名（36.4%）女性和 238 名（43.6%）男性死亡。在女性中，所有骨骼部位的 BMD（除脊柱 aBMD 和全身 aBMD 外）在未调整模型中与全因死亡率呈负相关。在桡骨中段（每标准差的危险比=0.79；p=0.0057）和桡骨远段（每标准差的危险比=0.76；p=0.0056）中，这些关联在调整所有协变量（包括瘦体重）后仍然显著。在男性中，体积 BMD 测量值而不是 aBMD 与死亡率呈负相关，并且仅在未调整模型中。在这项纵向研究中，T2D 女性的桡骨基线 aBMD 较低与全因死亡率增加相关，但男性则不然，且独立于其他死亡风险因素。
