Park Nicollet Clinic and HealthPartners Institute, HealthPartners Inc, Minneapolis, MN, United States of America; Division of Health Policy and Research, School of Public Health, University of Minnesota, United States of America.
McGill University, Montreal, Canada.
Bone. 2022 Jan;154:116220. doi: 10.1016/j.bone.2021.116220. Epub 2021 Sep 25.
Impaired bone quality, especially related to accumulation of advanced glycation end-products (AGEs) and higher incidence of falls contribute substantially to a higher risk of fracture associated with type 2 diabetes mellitus (T2DM). These factors may predispose to fractures more at skeletal sites where impaired bone toughness and falls play a larger pathogenic role (such as hip fractures) compared to skeletal sites where they are less important (such as vertebral fractures).
To determine if the associations of T2DM with prevalent and incident vertebral fractures are as strong as they are for hip and other non-vertebral fractures.
Amongst 80,238 individuals in the Manitoba Bone Density Program database (mean [SD] age 64.4 [11.1] years, 89.8% female, 8676 with diagnosed T2DM) with a baseline BMD test (1996-2016), we estimated hazard ratios (HRs) for incident clinical fracture at different skeletal sites in those with compared to those without T2DM using Cox proportional hazards models over a mean (SD) 9.0 (5.0) year follow-up period. We also estimated odds ratios for prevalent vertebral fracture on VFA images amongst 9594 individuals (mean [SD] 76 [6.8] years, 1185 with T2DM diagnosis at time of DXA-VFA) and for prior clinical fractures at different skeletal sites using logistic regression models.
After multivariable adjustment, T2DM was associated with incident hip (HR 1.63, 95% CI 1.44 to 1.85) and proximal humerus fractures (HR 1.59, 95% CI 1.39 to 1.83), but was not associated with incident forearm fracture (HR 1.00, 95% CI 0.86 to 1.17) and only weakly with incident clinical vertebral fracture (HR 1.16, 95% CI 1.01 to 1.33). Similarly, T2DM was associated with prior hip (OR 1.78, 95% CI 1.21 to 2.61) and prior proximal humerus fracture (OR 1.31, 95% CI 1.02 to 1.68) but not with prior forearm (OR 0.89, 95% CI 0.74 to 1.06) or prevalent vertebral fracture on VFA images (OR 0.91, 95% CI 0.77 to 1.08).
T2DM is a stronger risk factor for hip and proximal humerus fractures than for vertebral and wrist fractures. Further research is warranted to determine if the known differences in falls and/or bone quality between T2DM and age-related osteoporosis account for these differential associations.
骨质量受损，尤其是与晚期糖基化终产物（AGEs）积累和更高的跌倒发生率相关，这极大地增加了 2 型糖尿病（T2DM）患者骨折的风险。这些因素可能会使骨骼中韧性受损和跌倒起更大致病作用的部位（如髋部骨折）比那些作用较小的部位（如椎体骨折）更容易发生骨折。
确定 T2DM 与椎体和非椎体骨折的相关性是否与髋部及其他非椎体骨折一样强。
在马尼托巴骨密度计划数据库（80238 名参与者，平均[SD]年龄 64.4[11.1]岁，89.8%为女性，8676 名患有确诊的 T2DM）中，我们使用 Cox 比例风险模型在基线 BMD 检测（1996-2016 年）后，评估了患有和不患有 T2DM 的个体在不同骨骼部位发生新发临床骨折的风险比（HR）。我们还使用逻辑回归模型，在 9594 名参与者（平均[SD]年龄 76[6.8]岁，1185 名在 DXA-VFA 时诊断为 T2DM）中评估了 VFA 图像上的椎体骨折发生率和不同骨骼部位的既往临床骨折发生率的比值比（OR）。
经过多变量调整后，T2DM 与髋部（HR 1.63，95%CI 1.44 至 1.85）和近端肱骨骨折（HR 1.59，95%CI 1.39 至 1.83）的新发骨折相关，但与前臂骨折（HR 1.00，95%CI 0.86 至 1.17）无关，与新发临床椎体骨折的相关性也较弱（HR 1.16，95%CI 1.01 至 1.33）。同样，T2DM 与髋部（OR 1.78，95%CI 1.21 至 2.61）和近端肱骨骨折（OR 1.31，95%CI 1.02 至 1.68）的既往骨折相关，但与前臂（OR 0.89，95%CI 0.74 至 1.06）或 VFA 图像上的椎体骨折（OR 0.91，95%CI 0.77 至 1.08）无关。
T2DM 是髋部和近端肱骨骨折的危险因素，而非椎体和腕部骨折的危险因素。需要进一步研究以确定 T2DM 和与年龄相关的骨质疏松症之间在跌倒和/或骨质量方面的已知差异是否导致了这些不同的相关性。
