Department of Systems' Medicine, University of Roma "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy.
Department of Orthopaedics and Traumatology, University of Roma "Tor Vergata", Rome, Italy.
Acta Diabetol. 2018 Oct;55(10):1043-1050. doi: 10.1007/s00592-018-1187-y. Epub 2018 Jul 6.
Patients with type 2 diabetes mellitus (T2DM) have an increased risk of fractures, despite having greater bone mineral density (BMD) than non-diabetic subjects. This has led to the hypothesis that the presence of impaired bone quality among diabetics reduces bone strength. The Fracture Risk Assessment Score (FRAX) algorithm, introduced to facilitate the evaluation of fracture risk, underestimates the risk of fracture in diabetic patients. The purpose of this study is to confirm the relationship between the degree of metabolic compensation and the 10-year probability of a major fracture or a hip osteoporotic fracture observed in our previous study and to ascertain whether glycosylated hemoglobin (HbA) can improve the predictive value of FRAX in patients with T2DM.
Our data derive from a retrospective clinical study conducted at the "Tor Vergata" Polyclinic in Rome on 6355 subjects over 50 years of age evaluated for osteoporosis. All available clinical records were examined. HbA was available for 242 of these subjects and all had had a Dual-energy X-ray Absorption (DXA) scan of the lumbar spine and femoral neck. The risk of fracture was estimated using the Italian version of the FRAX algorithm.
Patients with T2DM had BMD and T-scores higher than those of non-diabetic subjects, while FRAX average values were higher in the non-diabetic group. HbA and FRAX are inversely correlated with each other: for each incremental percentage point of HbA growth, the FRAX major osteoporotic fracture probability is reduced by 0.915 points and the FRAX hip osteoporotic fracture probability by 1.438 points. The introduction of a correction factor derived from HbA, resulted in mean FRAX values of diabetic patients equivalent to those of non-diabetic subjects.
We propose a correction factor derived from HbA that could enhance the predictive ability of fracture risk estimated by the FRAX algorithm in subjects with T2DM.
尽管 2 型糖尿病（T2DM）患者的骨密度（BMD）高于非糖尿病患者，但他们骨折的风险仍然增加。这导致了一种假说，即糖尿病患者存在骨质量受损，从而降低了骨强度。引入骨折风险评估评分（FRAX）算法是为了方便评估骨折风险，但它低估了糖尿病患者骨折的风险。本研究的目的是确认我们之前研究中观察到的代谢代偿程度与 10 年内发生主要骨折或髋部骨质疏松性骨折的概率之间的关系，并确定糖化血红蛋白（HbA）是否可以提高 T2DM 患者 FRAX 的预测值。
我们的数据来自于罗马“Tor Vergata”综合医院进行的一项回顾性临床研究，该研究共纳入 6355 名 50 岁以上的骨质疏松症患者。检查了所有可用的临床记录。其中 242 名患者的 HbA 可用于分析，所有患者均进行了腰椎和股骨颈的双能 X 射线吸收（DXA）扫描。使用意大利版 FRAX 算法估计骨折风险。
T2DM 患者的 BMD 和 T 评分高于非糖尿病患者，而非糖尿病患者的 FRAX 平均值更高。HbA 与 FRAX 呈负相关：HbA 每增加 1%，FRAX 主要骨质疏松性骨折的概率降低 0.915 分，FRAX 髋部骨质疏松性骨折的概率降低 1.438 分。引入由 HbA 衍生的校正因子后，糖尿病患者的平均 FRAX 值与非糖尿病患者相当。
我们提出了一个由 HbA 衍生的校正因子，可以提高 FRAX 算法估计的 T2DM 患者骨折风险的预测能力。
