Division of Endocrinology, Diabetes and Metabolism at Baylor College of Medicine, Houston, TX, USA.
Michael E. DeBakey VA Medical Center, Houston, TX, USA.
J Clin Endocrinol Metab. 2021 Apr 23;106(5):1362-1376. doi: 10.1210/clinem/dgab061.
Obesity and type 2 Diabetes (T2D) are both associated with greater bone mineral density (BMD) but increased risk of fractures. The effect of the combination of both conditions on bone metabolism, microarchitecture, and strength in the obese population remains unknown.
Data from 112 obese men were collected. Bone turnover and biochemical markers were measured by enzyme-linked immunosorbent assay, body composition and BMD at all sites were assessed by dual energy X-ray absorptiometry, whereas bone microarchitecture and strength (stiffness and failure load) were measured by high-resolution peripheral computed tomography. Data were compared among metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO) with and without T2D and between obese without and with T2D.
Compared to MHO and MUHO without T2D, MUHO with T2D had significantly lower levels of osteocalcin ((7.49 ± 3.0 and 6.03 ± 2.47 vs 4.24 ± 2.72 ng/mL, respectively, P = 0.003) and C-terminal telopeptide of type I collagen (CTx) (0.28 ± 0.10 and 0.29 ± 0.13 vs 0.21 ± 0.15 ng/mL, respectively, P = 0.02). Dividing our subjects simply into those with and without T2D showed that obese men with T2D had significantly lower levels of osteocalcin (P = 0.003) and CTx (P = 0.005), greater trabecular separation at the tibia and radius (P = 0.03 and P = 0.04, respectively), and lower tibial failure load and stiffness (both P = 0.04), relative to obese men without T2D.
In men, the combination of obesity and T2D is associated with reduced bone turnover and poorer trabecular bone microarchitecture and bone strength compared to those who are obese but without T2D, suggesting worse bone disease.
肥胖和 2 型糖尿病（T2D）均与较高的骨密度（BMD）相关，但骨折风险增加。肥胖人群中，这两种情况同时存在对骨代谢、微结构和强度的影响尚不清楚。
收集了 112 名肥胖男性的数据。通过酶联免疫吸附测定法测量骨转换和生化标志物，通过双能 X 射线吸收法评估所有部位的身体成分和 BMD，通过高分辨率外周计算机断层扫描测量骨微结构和强度（刚度和失效负荷）。比较了代谢健康的肥胖（MHO）和代谢不健康的肥胖（MUHO）伴或不伴 T2D 以及肥胖不伴和伴 T2D 患者之间的数据。
与 MHO 和 MUHO 无 T2D 相比，MUHO 伴 T2D 患者的骨钙素水平显著降低（（7.49±3.0 和 6.03±2.47 与 4.24±2.72ng/mL，分别，P=0.003）和 I 型胶原 C 端肽（CTX）（0.28±0.10 和 0.29±0.13 与 0.21±0.15ng/mL，分别，P=0.02）。简单地将我们的研究对象分为伴或不伴 T2D 的患者，发现伴 T2D 的肥胖男性骨钙素（P=0.003）和 CTx（P=0.005）水平显著降低，胫骨和桡骨的小梁分离程度更大（P=0.03 和 P=0.04，分别），胫骨失效负荷和刚度较低（均 P=0.04），与不伴 T2D 的肥胖男性相比。
在男性中，与肥胖但无 T2D 相比，肥胖和 T2D 同时存在与骨转换减少和小梁骨微结构及骨强度降低有关，提示骨病更严重。
