Department of Neurosurgery, Gyeongsang National University, Gyeongsang National University Hospital, 79, Gangnam-ro, Jinju-si, Gyeongsangnam-do, 52727, Republic of Korea.
International Collaboration On Repair Discoveries (ICORD), University of British Columbia, 818 W 10th Ave, Vancouver, British Columbia V5Z1M9 Canada.
Spine J. 2018 Oct;18(10):1877-1887. doi: 10.1016/j.spinee.2018.05.020. Epub 2018 May 21.
Diabetes and menopause can cause severe osteoporosis. In general, menopause and diabetes can lead to an imbalance in bone turnover, which results in secondary osteoporosis. However, the efficacy of antiresorptive drugs against this form of osteoporosis has not been extensively evaluated.
The aim of this study was to determine the changes in vertebral bone remodeling when postmenopausal osteoporosis is accompanied by diabetes and to compare the efficacy of bisphosphonates and selective estrogen-receptor modulators (SERMs) against these outcomes.
Streptozotocin-induced diabetic, ovariectomized Sprague-Dawley rats were used as the disease model. Alendronate and raloxifene were used as the bisphosphonate and SERM, respectively.
We divided 62 female rats into five groups: (1) control (n=14), (2) DM (diabetes) (n=12), (3) DM+OVX (diabetes+ovariectomy) (n=12), (4) DM+OVX+A (diabetes+ovariectomy+alendronate) (n=12), and (5) DM+OVX+R (diabetes+ovariectomy+raloxifene) (n=12). Serum biochemical markers of bone turnover, including osteocalcin and the C-telopeptide of type I collagen (CTX-1), were analyzed. We measured histomorphometric parameters of the fourth lumbar vertebrae using microcomputed tomography. Mechanical strength was evaluated by a compression test.
In the DM and DM+OVX group, only the levels of osteocalcin significantly decreased compared with those of the control group at 8 weeks after OVX. At 12 weeks, the serum CTX-1 levels in the DM+OVX+A and DM+OVX+R groups were significantly lower than those of the DM+OVX group, but there were no changes in the levels of osteocalcin. Bone mineral density and mechanical strength were higher in the DM+OVX+A and DM+OVX+R groups than in the DM and DM+OVX groups (p<.05).
Even if postmenopausal osteoporosis is accompanied by diabetes in this animal model, both alendronate and raloxifene seem to show antiresorptive effects, decreased bone turnover rates, and improved bone mechanical strength. Therefore, alendronate and raloxifene are effective in the treatment of osteoporosis even for bone loss caused by DM and postmenopausal osteoporosis.
糖尿病和更年期会导致严重的骨质疏松症。一般来说，更年期和糖尿病会导致骨转换失衡，从而导致继发性骨质疏松症。然而，针对这种形式的骨质疏松症，抗吸收药物的疗效尚未得到广泛评估。
本研究旨在确定绝经后骨质疏松症合并糖尿病时椎体骨重塑的变化，并比较双膦酸盐和选择性雌激素受体调节剂（SERMs）对这些结果的疗效。
使用链脲佐菌素诱导的糖尿病、去卵巢 Sprague-Dawley 大鼠作为疾病模型。阿仑膦酸钠和雷洛昔芬分别用作双膦酸盐和 SERM。
我们将 62 只雌性大鼠分为五组：（1）对照组（n=14）、（2）糖尿病组（DM）（n=12）、（3）糖尿病+去卵巢组（DM+OVX）（n=12）、（4）糖尿病+去卵巢+阿仑膦酸钠组（DM+OVX+A）（n=12）和（5）糖尿病+去卵巢+雷洛昔芬组（DM+OVX+R）（n=12）。分析血清骨转换生化标志物，包括骨钙素和 I 型胶原 C 端肽（CTX-1）。使用微计算机断层扫描测量第四腰椎的组织形态计量学参数。通过压缩试验评估机械强度。
在 DM 和 DM+OVX 组中，仅在去卵巢 8 周后，骨钙素水平与对照组相比显著降低。在 12 周时，DM+OVX+A 和 DM+OVX+R 组的血清 CTX-1 水平明显低于 DM+OVX 组，但骨钙素水平没有变化。DM+OVX+A 和 DM+OVX+R 组的骨密度和机械强度均高于 DM 和 DM+OVX 组（p<.05）。
即使在这种动物模型中，绝经后骨质疏松症伴有糖尿病，阿仑膦酸钠和雷洛昔芬似乎都表现出抗吸收作用，降低了骨转换率，并改善了骨机械强度。因此，阿仑膦酸钠和雷洛昔芬在治疗骨质疏松症方面是有效的，即使是由 DM 和绝经后骨质疏松症引起的骨丢失也是如此。
