非糖尿病绝经后女性胰岛素抵抗（HOMA-IR）、骨小梁评分（TBS）与三维双能X线吸收法（3D-DXA）之间的关系
Relationship between Insulin Resistance (HOMA-IR), Trabecular Bone Score (TBS), and Three-Dimensional Dual-Energy X-ray Absorptiometry (3D-DXA) in Non-Diabetic Postmenopausal Women.
作者信息
Campillo-Sánchez Francisco, Usategui-Martín Ricardo, Ruiz-de Temiño Ángela, Gil Judith, Ruiz-Mambrilla Marta, Fernández-Gómez Jose María, Dueñas-Laita Antonio, Pérez-Castrillón José Luis
机构信息
Gynaecology Department, Hospital Clínico Universitario Valladolid, 47003 Valladolid, Spain.
IOBA, University of Valladolid, 47011 Valladolid, Spain.
出版信息
J Clin Med. 2020 Jun 3;9(6):1732. doi: 10.3390/jcm9061732.
BACKGROUND
Insulin may play a key role in bone metabolism, where the anabolic effect predominates. This study aims to analyze the relationship between insulin resistance and bone quality using the trabecular bone score (TBS) and three-dimensional dual-energy X-ray absorptiometry (3D-DXA) in non-diabetic postmenopausal women by determining cortical and trabecular compartments.
METHODS
A cross-sectional study was conducted in non-diabetic postmenopausal women with suspected or diagnosed osteoporosis. The inclusion criteria were no menstruation for more than 12 months and low bone mass or osteoporosis as defined by DXA. Glucose was calculated using a Hitachi 917 auto-analyzer. Insulin was determined using an enzyme-linked immunosorbent assay (EIA). Insulin resistance was estimated using a homeostasis model assessment of insulin resistance (HOMA-IR). DXA, 3D-DXA, and TBS were thus collected. Moreover, we examined bone parameters according to quartile of insulin, hemoglobin A1C (HbA1c), and HOMA-IR.
RESULTS
In this study, we included 381 postmenopausal women. Women located in quartile 4 (Q4) of HOMA-IR had higher values of volumetric bone mineral density (vBMD) but not TBS. The increase was higher in the trabecular compartment (16.4%) than in the cortical compartment (6.4%). Similar results were obtained for insulin. Analysis of the quartiles by HbA1c showed no differences in densitometry values, however women in Q4 had lower levels of TBS. After adjusting for BMI, statistical significance was maintained for TBS, insulin, HOMA-IR, and HbA1c.
CONCLUSIONS
In non-diabetic postmenopausal women there was a direct relationship between insulin resistance and vBMD, whose effect is directly related to greater weight. TBS had an inverse relationship with HbA1c, insulin, and insulin resistance unrelated to weight. This might be explained by the formation of advanced glycosylation products (AGEs) in the bone matrix, which reduces bone deformation capacity and resistance, as well as increases fragility.
背景
胰岛素可能在以合成代谢作用为主的骨代谢中发挥关键作用。本研究旨在通过测定皮质骨和小梁骨部分，利用小梁骨评分（TBS）和三维双能X线吸收法（3D-DXA）分析非糖尿病绝经后女性胰岛素抵抗与骨质量之间的关系。
方法
对疑似或诊断为骨质疏松症的非糖尿病绝经后女性进行横断面研究。纳入标准为停经超过12个月且根据双能X线吸收法（DXA）定义的低骨量或骨质疏松症。使用日立917自动分析仪计算血糖。使用酶联免疫吸附测定（EIA）法测定胰岛素。使用胰岛素抵抗稳态模型评估（HOMA-IR）估计胰岛素抵抗。由此收集了DXA、3D-DXA和TBS数据。此外，我们根据胰岛素、糖化血红蛋白（HbA1c）和HOMA-IR的四分位数检查了骨参数。
结果
本研究纳入了381名绝经后女性。处于HOMA-IR四分位数4（Q4）的女性骨体积密度（vBMD）值较高，但TBS值并非如此。小梁骨部分的增加（16.4%）高于皮质骨部分（6.4%）。胰岛素也得到了类似结果。按HbA1c分析四分位数显示骨密度测量值无差异，然而Q4中的女性TBS水平较低。在调整体重指数（BMI）后，TBS、胰岛素、HOMA-IR和HbA1c仍具有统计学意义。
结论
在非糖尿病绝经后女性中，胰岛素抵抗与vBMD之间存在直接关系，其作用与体重增加直接相关。TBS与HbA1c、胰岛素和胰岛素抵抗呈负相关，且与体重无关。这可能是由于骨基质中晚期糖基化终末产物（AGEs）的形成，其降低了骨变形能力和抵抗力，并增加了脆性。
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