Yang Jaewon, Hong Namki, Shim Jee-Seon, Rhee Yumie, Kim Hyeon Chang
Department of Public Health, Yonsei University Graduate School, Seoul, Korea.
Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.
J Bone Metab. 2018 May;25(2):123-132. doi: 10.11005/jbm.2018.25.2.123. Epub 2018 May 31.
Type 2 diabetes mellitus is associated with an increased risk of osteoporotic fracture despite relatively preserved bone mineral density (BMD). Although this paradox might be attributed to the influence of insulin resistance (IR) on bone structure and material properties, the association of IR with femur bone geometry and strength indices remains unclear.
Using data from the Cardiovascular and Metabolic Disease Etiology Research Center cohort study, we conducted a cross-sectional analysis among nondiabetic postmenopausal women. IR was estimated using the homeostasis model assessment of IR (HOMA-IR). Compartment-specific volumetric BMD (vBMD) and bone volume of proximal femur were measured using quantitative computed tomography. The compressive strength index (CSI), section modulus (Z), and buckling ratio of the femoral neck were calculated as bone strength indices.
Among 1,008 subjects (mean age, 57.3 years; body mass index [BMI], 23.6 kg/m), BMI, waist circumference, and vBMD of the femoral neck and total hip increased in a linear trend from the lowest (<1.37) to highest (≥2.27) HOMA-IR quartile (<0.05 for all). The HOMA-IR showed an independent negative association with total bone volume (standardized β=-0.12), cortical volume (β=-0.05), CSI (β=-0.013), and Z (β=-0.017; <0.05 for all) of the femoral neck after adjustment for age, weight, height, physical activity, and vitamin D and high-sensitivity C-reactive protein levels. However, the association between HOMA-IR and vBMD was attenuated in the adjusted model (femoral neck, β=0.94; =0.548).
Elevated HOMA-IR was associated with lower cortical bone volume and bone strength indices in nondiabetic postmenopausal women, independent of age and body size.
2型糖尿病与骨质疏松性骨折风险增加相关，尽管骨矿物质密度（BMD）相对保持正常。虽然这种矛盾现象可能归因于胰岛素抵抗（IR）对骨骼结构和材料特性的影响，但IR与股骨骨几何形状和强度指标之间的关联仍不清楚。
利用心血管和代谢疾病病因研究中心队列研究的数据，我们对非糖尿病绝经后女性进行了横断面分析。使用IR的稳态模型评估（HOMA-IR）来估计IR。使用定量计算机断层扫描测量股骨近端特定区域的体积骨密度（vBMD）和骨体积。计算股骨颈的抗压强度指数（CSI）、截面模量（Z）和屈曲比作为骨强度指标。
在1008名受试者（平均年龄57.3岁；体重指数[BMI]23.6kg/m²）中，股骨颈和全髋的BMI、腰围和vBMD从最低（<1.37）到最高（≥2.27）HOMA-IR四分位数呈线性增加趋势（均P<0.05）。在调整年龄、体重、身高、体力活动、维生素D和高敏C反应蛋白水平后，HOMA-IR与股骨颈的总骨体积（标准化β=-0.12）、皮质骨体积（β=-0.05）、CSI（β=-0.013）和Z（β=-0.017；均P<0.05）呈独立负相关。然而，在调整模型中，HOMA-IR与vBMD之间的关联减弱（股骨颈，β=0.94；P=0.548）。
在非糖尿病绝经后女性中，HOMA-IR升高与较低的皮质骨体积和骨强度指标相关，且独立于年龄和体型。
