2型糖尿病患者的骨质疏松症与骨折风险
OSTEOPOROSIS AND FRACTURE RISK IN PATIENTS WITH TYPE 2 DIABETES MELLITUS.
作者信息
Poiana C, Capatina C
机构信息
"Carol Davila" University of Medicine and Pharmacy - Endocrinology, Bucharest, Romania.
"C.I.Parhon" National Institute of Endocrinology, Bucharest, Romania.
出版信息
Acta Endocrinol (Buchar). 2019 Apr-Jun;15(2):231-236. doi: 10.4183/aeb.2019.231.
Abstract
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of fragility fractures compared to the general population. The pathogenesis of the elevated fracture risk is multifactorial and still largely elusive. In contrast to primary osteoporosis, in T2DM the bone mineral density (BMD) is increased compared to controls, suggesting that specific alterations in bone quality occur in diabetic patients. Even more, the specific increase in BMD observed in these patients impairs at least in part both the classical diagnosis of osteoporosis by dual-energy X-ray absorptiometry (DXA) and the current fracture risk estimation by FRAX (fracture risk assessment tool). Trabecular bone score (TBS) and TBS-adjusted FRAX could improve fracture risk estimation in patients with T2DM but improved tools are needed in the future as well as specific risk stratification criteria. Decreases in the fracture risk of patients with T2DM can be obtained by optimal diabetes control and standard treatment of osteoporosis (most drugs appear to have similar efficacy in patients with T2DM and primary osteoporosis).
摘要
与普通人群相比，2型糖尿病（T2DM）患者发生脆性骨折的风险增加。骨折风险升高的发病机制是多因素的，目前仍不清楚。与原发性骨质疏松症不同，T2DM患者的骨密度（BMD）较对照组增加，这表明糖尿病患者的骨质量发生了特定改变。此外，这些患者中观察到的BMD特异性增加至少在一定程度上损害了双能X线吸收法（DXA）对骨质疏松症的经典诊断以及FRAX（骨折风险评估工具）目前对骨折风险的评估。骨小梁骨评分（TBS）和经TBS调整的FRAX可以改善T2DM患者的骨折风险评估，但未来仍需要改进的工具以及特定的风险分层标准。通过优化糖尿病控制和骨质疏松症的标准治疗（大多数药物在T2DM患者和原发性骨质疏松症患者中似乎具有相似的疗效），可以降低T2DM患者的骨折风险。
相似文献
1
OSTEOPOROSIS AND FRACTURE RISK IN PATIENTS WITH TYPE 2 DIABETES MELLITUS.2型糖尿病患者的骨质疏松症与骨折风险
Acta Endocrinol (Buchar). 2019 Apr-Jun;15(2):231-236. doi: 10.4183/aeb.2019.231.
2
Trabecular Bone Score (TBS) and TBS-Adjusted Fracture Risk Assessment Tool are Potential Supplementary Tools for the Discrimination of Morphometric Vertebral Fractures in Postmenopausal Women With Type 2 Diabetes.骨小梁评分（TBS）和经TBS调整的骨折风险评估工具是鉴别2型糖尿病绝经后女性形态计量学椎体骨折的潜在补充工具。
J Clin Densitom. 2016 Oct;19(4):507-514. doi: 10.1016/j.jocd.2016.04.001. Epub 2016 Apr 27.
3
Fracture Risk Assessment in Patients With Diabetes Mellitus.糖尿病患者的骨折风险评估
J Clin Densitom. 2017 Jul-Sep;20(3):432-443. doi: 10.1016/j.jocd.2017.06.011. Epub 2017 Jul 14.
4
Fracture risk assessment in postmenopausal women with diabetes: comparison between DeFRA and FRAX tools.绝经后糖尿病女性的骨折风险评估：DeFRA与FRAX工具的比较
Gynecol Endocrinol. 2018 May;34(5):404-408. doi: 10.1080/09513590.2017.1407308. Epub 2017 Nov 24.
5
Use of Trabecular Bone Score (TBS) as a Complementary Approach to Dual-energy X-ray Absorptiometry (DXA) for Fracture Risk Assessment in Clinical Practice.在临床实践中使用小梁骨评分（TBS）作为双能X线吸收法（DXA）的补充方法进行骨折风险评估。
J Clin Densitom. 2017 Jul-Sep;20(3):334-345. doi: 10.1016/j.jocd.2017.06.019. Epub 2017 Jul 19.
6
Status of bone strength and factors associated with vertebral fracture in postmenopausal women with type 2 diabetes.绝经后 2 型糖尿病女性的骨强度状况及与椎体骨折相关的因素。
Menopause. 2019 Feb;26(2):182-188. doi: 10.1097/GME.0000000000001185.
7
Comparison of trabecular bone score and hip structural analysis with FRAX in postmenopausal women with type 2 diabetes mellitus.2型糖尿病绝经后女性中骨小梁评分和髋部结构分析与FRAX的比较
Aging Clin Exp Res. 2017 Oct;29(5):951-957. doi: 10.1007/s40520-016-0634-2. Epub 2016 Oct 8.
8
The Trabecular Bone Score (TBS) Complements DXA and the FRAX as a Fracture Risk Assessment Tool in Routine Clinical Practice.TBS（骨小梁评分）作为一种骨折风险评估工具，与 DXA 和 FRAX 联合使用，可以补充常规临床实践中的评估方法。
Curr Osteoporos Rep. 2017 Dec;15(6):521-531. doi: 10.1007/s11914-017-0410-z.
9
DXA-Based Measurements in Diabetes: Can They Predict Fracture Risk?基于 DXA 的糖尿病测量：它们能预测骨折风险吗？
Calcif Tissue Int. 2017 Feb;100(2):150-164. doi: 10.1007/s00223-016-0191-x. Epub 2016 Sep 3.
10
Usefulness of Trabecular Bone Score (TBS) to Identify Bone Fragility in Patients with Primary Hyperparathyroidism.TBS 在原发性甲状旁腺功能亢进症患者骨脆性评估中的作用。
J Clin Densitom. 2019 Apr-Jun;22(2):162-170. doi: 10.1016/j.jocd.2018.06.005. Epub 2018 Jun 27.
引用本文的文献
1
Correlation between thyroid sensitivity indices and bone metabolism in newly diagnosed middle aged and elderly patients with type 2 diabetes mellitus with normal thyroid function.新诊断的甲状腺功能正常的中老年2型糖尿病患者甲状腺敏感性指标与骨代谢的相关性
BMC Endocr Disord. 2025 Sep 5;25(1):206. doi: 10.1186/s12902-025-02030-y.
2
HMGB1 and TLR4 as biomarkers for osteoporosis risk in type 2 diabetes mellitus: a cross-sectional study.HMGB1和TLR4作为2型糖尿病骨质疏松风险的生物标志物：一项横断面研究。
BMC Endocr Disord. 2025 Jul 14;25(1):175. doi: 10.1186/s12902-025-01998-x.
3
The hidden influence of type 2 diabetes on bone mineral density across the lifespan: a Mendelian randomization study.2型糖尿病对全生命周期骨密度的潜在影响：一项孟德尔随机化研究
Hormones (Athens). 2025 Jun 18. doi: 10.1007/s42000-025-00687-7.
4
A Sex Comparison of Fall and Fracture Occurrence in the Elderly Diabetic Population: A Quantitative Study.老年糖尿病患者跌倒与骨折发生情况的性别比较：一项定量研究。
Womens Health Rep (New Rochelle). 2025 Mar 6;6(1):230-235. doi: 10.1089/whr.2024.0158. eCollection 2025.
5
Osteoporosis as the Female-Specific Risk Factor for Dynapenia in Elderly Patients with Type 2 Diabetes.骨质疏松症作为老年2型糖尿病患者肌肉减少症的女性特异性危险因素。
J Clin Med. 2024 Aug 6;13(16):4590. doi: 10.3390/jcm13164590.
6
[Not Available].[不可用]。
Adv Lab Med. 2024 Mar 25;5(1):90-95. doi: 10.1515/almed-2024-0033. eCollection 2024 Mar.
7
Effects of antidiabetic drugs on bone metabolism.抗糖尿病药物对骨代谢的影响。
Adv Lab Med. 2024 Apr 3;5(1):85-89. doi: 10.1515/almed-2024-0038. eCollection 2024 Mar.
8
INSULIN RESISTANCE AND PATHOGENESIS OF POSTMENOPAUSAL OSTEOPOROSIS.胰岛素抵抗与绝经后骨质疏松症的发病机制
Acta Endocrinol (Buchar). 2023 Jul-Sep;19(3):349-363. doi: 10.4183/aeb.2023.349. Epub 2024 Feb 1.
9
The role of advanced glycation end products in fracture risk assessment in postmenopausal type 2 diabetic patients.晚期糖基化终产物在绝经后 2 型糖尿病患者骨折风险评估中的作用。
Front Endocrinol (Lausanne). 2022 Dec 12;13:1013397. doi: 10.3389/fendo.2022.1013397. eCollection 2022.
10
Comparison of Trabecular Bone Score-Adjusted Fracture Risk Assessment (TBS-FRAX) and FRAX Tools for Identification of High Fracture Risk among Taiwanese Adults Aged 50 to 90 Years with or without Prediabetes and Diabetes.比较 TBS-FRAX（骨小梁评分调整骨折风险评估）和 FRAX 工具在识别有无糖尿病的 50 岁至 90 岁台湾成年人中骨折高风险的应用。
Medicina (Kaunas). 2022 Nov 30;58(12):1766. doi: 10.3390/medicina58121766.
本文引用的文献
1
ADIPONECTIN AS A POTENTIAL BIOMARKER OF LOW BONE MINERAL DENSITY IN POSTMENOPAUSAL WOMEN WITH METABOLIC SYNDROME.脂联素作为代谢综合征绝经后女性低骨密度的潜在生物标志物
Acta Endocrinol (Buchar). 2018 Apr-Jun;14(2):201-207. doi: 10.4183/aeb.2018.201.
2
EFFECT OF EXPERIMENTAL DYSGLYCEMIA ON UNDER-CARBOXYLATED OSTEOCALCIN PRODUCTION IN HUMAN PRIMARY OSTEOBLAST-LIKE CELL CULTURES.实验性血糖异常对人原代成骨样细胞培养物中羧基化不足骨钙素产生的影响。
Acta Endocrinol (Buchar). 2018 Jan-Mar;14(1):11-15. doi: 10.4183/aeb.2018.11.
3
Hyperglycemic status is associated with an elevated risk of osteoporotic fracture in community-dwelling elderly Japanese men: The Fujiwara-kyo osteoporosis risk in men (FORMEN) cohort study.高血糖状态与社区居住的老年日本男性骨质疏松性骨折风险升高相关：岩手县骨质疏松症男性风险（FORMEN）队列研究。
Bone. 2019 Apr;121:100-106. doi: 10.1016/j.bone.2019.01.005. Epub 2019 Jan 5.
4
Discordant pattern of peripheral fractures in diabetes: a meta-analysis on the risk of wrist and ankle fractures.糖尿病周围骨折的不典型模式：腕部和踝部骨折风险的荟萃分析。
Osteoporos Int. 2019 Jan;30(1):135-143. doi: 10.1007/s00198-018-4717-0. Epub 2018 Oct 10.
5
Efficacy of anti-osteoporotic medications in patients with type 1 and 2 diabetes mellitus: a systematic review.1 型和 2 型糖尿病患者抗骨质疏松药物的疗效：系统评价。
Endocrine. 2018 Jun;60(3):373-383. doi: 10.1007/s12020-018-1548-x. Epub 2018 Feb 6.
6
Type 2 diabetes mellitus and bone.2 型糖尿病与骨骼。
J Intern Med. 2018 Feb;283(2):140-153. doi: 10.1111/joim.12725. Epub 2018 Jan 8.
7
DXA-Based Measurements in Diabetes: Can They Predict Fracture Risk?基于 DXA 的糖尿病测量：它们能预测骨折风险吗？
Calcif Tissue Int. 2017 Feb;100(2):150-164. doi: 10.1007/s00223-016-0191-x. Epub 2016 Sep 3.
8
Lack of evidence for a harmful effect of sodium-glucose co-transporter 2 (SGLT2) inhibitors on fracture risk among type 2 diabetes patients: a network and cumulative meta-analysis of randomized controlled trials.缺乏证据表明钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂对2型糖尿病患者骨折风险有有害影响：一项随机对照试验的网络和累积荟萃分析。
Diabetes Obes Metab. 2016 Dec;18(12):1199-1206. doi: 10.1111/dom.12742. Epub 2016 Aug 15.
9
Trabecular Bone Score (TBS) and TBS-Adjusted Fracture Risk Assessment Tool are Potential Supplementary Tools for the Discrimination of Morphometric Vertebral Fractures in Postmenopausal Women With Type 2 Diabetes.骨小梁评分（TBS）和经TBS调整的骨折风险评估工具是鉴别2型糖尿病绝经后女性形态计量学椎体骨折的潜在补充工具。
J Clin Densitom. 2016 Oct;19(4):507-514. doi: 10.1016/j.jocd.2016.04.001. Epub 2016 Apr 27.
10
Increased risk of vertebral fracture in patients with diabetes: a meta-analysis of cohort studies.糖尿病患者椎体骨折风险增加：队列研究的荟萃分析
Int Orthop. 2016 Jun;40(6):1299-307. doi: 10.1007/s00264-016-3146-y. Epub 2016 Mar 31.
Zotero 插件