治疗糖尿病患者的骨质疏松症：抗吸收剂与合成代谢剂？
Treatment of bone fragility in patients with diabetes: antiresorptive versus anabolic?
机构信息
Metabolic Bone Disease Center, State University of New York Upstate Medical University, Syracuse, New York.
Bone and Mineral Research Laboratory, Henry Ford Hospital, Detroit, Michigan, USA.
出版信息
Curr Opin Endocrinol Diabetes Obes. 2021 Aug 1;28(4):377-382. doi: 10.1097/MED.0000000000000645.
PURPOSE OF REVIEW
The pathogenesis of bone fragility in diabetes has not been fully characterized. The antifracture efficacy of available therapies remains unproven in patients with diabetes. We aim to collate current evidence of the treatment of diabetic bone fragility, and to provide a rationale for considering optimal therapeutic option in patients with diabetes.
RECENT FINDINGS
The antifracture efficacy of antiresorptive and anabolic therapies is well established in patients without diabetes. Studies in patients with osteoporosis have shown that anabolic therapies lead to faster and larger benefits to bone mineral density and offer greater protection against fracture than antiresorptive therapies. Available data suggest that antiresorptive and anabolic therapies have similar effect on bone density and fracture risk reduction in patients with and without diabetes. However, the evidence in diabetes is limited to observational studies and post hoc analyses of osteoporosis studies.
SUMMARY
There are no specific guidelines for the treatment of bone fragility in patients with diabetes. We offer a rationale for use of anabolic therapies in diabetes which is a low bone formation state, in contrast to postmenopausal osteoporosis that is characterized by increased bone turnover. Prospective studies evaluating the effect of available therapies on bone quality and fracture outcomes in patients with diabetes are needed.
目的综述
糖尿病患者的骨脆弱发病机制尚未完全阐明。现有治疗方法在糖尿病患者中的抗骨折疗效仍未得到证实。我们旨在整理糖尿病性骨脆弱治疗的现有证据，并为考虑糖尿病患者的最佳治疗选择提供依据。
最近的发现
抗吸收和合成代谢疗法在无糖尿病患者中的抗骨折疗效已得到充分证实。骨质疏松症患者的研究表明，合成代谢疗法可更快、更大幅度地增加骨密度，并提供更大的骨折保护作用，优于抗吸收疗法。现有数据表明，抗吸收和合成代谢疗法对有和无糖尿病患者的骨密度和骨折风险降低具有相似的效果。然而，糖尿病方面的证据仅限于观察性研究和骨质疏松症研究的事后分析。
总结
目前尚无针对糖尿病患者骨脆弱治疗的具体指南。我们为在糖尿病中使用合成代谢疗法提供了依据，因为糖尿病是一种低骨形成状态，与以骨转换增加为特征的绝经后骨质疏松症相反。需要前瞻性研究评估现有治疗方法对糖尿病患者的骨质量和骨折结局的影响。
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