Poiana C, Capatina C
"Carol Davila" University of Medicine and Pharmacy - Endocrinology, Bucharest, Romania.
"C.I.Parhon" National Institute of Endocrinology, Bucharest, Romania.
Acta Endocrinol (Buchar). 2019 Apr-Jun;15(2):231-236. doi: 10.4183/aeb.2019.231.
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).
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。
