Division of Endocrinology and Diabetes, University Campus Bio-Medico di Roma, Rome, Italy.
Division of Bone Mineral Diseases, Washington University in Saint Louis, Saint Louis, Missouri.
J Clin Endocrinol Metab. 2019 Aug 1;104(8):3303-3310. doi: 10.1210/jc.2018-02539.
Adults with type 2 diabetes (T2D) have higher fracture risk compared with nondiabetics, despite having higher bone mineral density (BMD). Insulin resistance (IR) has been associated with increased BMD. It is not known if IR increases fracture risk.
We investigated the relationship among IR HOMA-IR, BMD, and incident nonspine fractures in nondiabetic individuals.
Participants included 2398 community-dwelling, nondiabetic older adults (age 74 ± 3 years, 53% women, 38% black) in the Health, Aging and Body Composition Prospective Cohort Study [median follow-up: 12 (interquartile range: 6) years].
The cut-off values for the HOMA-IR quartiles were 1.05, 1.54, and 2.33. Total hip BMD was 0.104 g/cm2 higher in the fourth vs the first HOMA-IR quartile (P < 0.001). This difference was attenuated after adjustment for BMI (adjusted mean difference 0.007 g/cm2; P = 0.371). In unadjusted models, fracture risk was lower in those with higher HOMA-IR [hazard ratio (HR) 0.86 (95% CI 0.73 to 1.01) and 0.65 (95% CI 0.47 to 0.89) for the third and fourth quartile, respectively, vs the first quartile]. However, after adjustment for BMD and BMI, fracture risk was significantly higher in the third quartile (HR 1.19, 95% CI 1.00 to 1.41) and tended to be increased in the fourth quartile (HR 1.12, 95% CI 0.87 to 1.46) vs the first quartile.
Greater IR is associated with higher BMD in nondiabetic older adults. In contrast to the relationship between T2D and fracture risk, we did not find consistent evidence that greater IR is associated with increased fracture risk after adjustment for BMI and BMD.
相较于非糖尿病患者，2 型糖尿病（T2D）患者的骨折风险更高，尽管他们的骨矿物质密度（BMD）更高。胰岛素抵抗（IR）与 BMD 增加有关。目前尚不清楚 IR 是否会增加骨折风险。
我们旨在研究非糖尿病个体中 IR（HOMA-IR）、BMD 和非脊柱骨折事件之间的关系。
参与者为健康、衰老和身体成分前瞻性队列研究中的 2398 名居住在社区的非糖尿病老年受试者（年龄 74 ± 3 岁，53%为女性，38%为黑人）[中位随访时间：12（四分位间距：6）年]。
HOMA-IR 四分位数的截止值分别为 1.05、1.54 和 2.33。第四四分位与第一四分位相比，全髋 BMD 高 0.104 g/cm2（P < 0.001）。这种差异在调整 BMI 后减弱（调整平均差值 0.007 g/cm2；P = 0.371）。在未调整的模型中，较高的 HOMA-IR 与较低的骨折风险相关[第 3 四分位和第 4 四分位的风险比（HR）分别为 0.86（95%CI 0.73 至 1.01）和 0.65（95%CI 0.47 至 0.89），与第 1 四分位相比]。然而，在调整 BMD 和 BMI 后，第 3 四分位的骨折风险显著升高（HR 1.19，95%CI 1.00 至 1.41），第 4 四分位的骨折风险有升高趋势（HR 1.12，95%CI 0.87 至 1.46），与第 1 四分位相比。
非糖尿病老年个体中较高的 IR 与较高的 BMD 相关。与 T2D 和骨折风险之间的关系相反，我们没有发现一致的证据表明，在调整 BMI 和 BMD 后，较高的 IR 与骨折风险增加相关。
