Marmara University School of Medicine, Department of Endocrinology and Metabolism, Istanbul, Turkey.
Marmara University School of Medicine, Department of Endocrinology and Metabolism, Istanbul, Turkey.
J Clin Densitom. 2022 Jul-Sep;25(3):373-379. doi: 10.1016/j.jocd.2021.11.010. Epub 2021 Nov 24.
Although the risk of bone fracture is increased in type 2 diabetes (T2DM), bone mineral density (BMD) is increased rather than decreased. Accumulation of advanced glycation end products (AGEs) adversely influences the fracture resistance of bone in T2DM. We hypothesized that SAF is also associated with BMD levels in type 2 diabetic patients and aimed to evaluate the association of SAF with BMD and the presence of osteoporosis. This cross-sectional case-control study included 237 patients with T2DM (F/M: 133/104, 56.2±11.9 yrs) and 100 age- and sex-matched controls (F/M: 70/30, 54.8±8.8 yrs). Skin autofluorescence, a validated non-invasive measure of tissue AGEs, is used to detect the accumulation of AGEs in skin collagen using AGE Reader (DiagnOptics B.V., Groningen, The Netherlands). In addition, BMD was measured with DEXA (Lunar DPX-L). Patients with T2DM had higher SAF values compared to control group (2.21±0.53 AU vs. 1.79±0.33 AU, p < 0.001). Male subjects had higher SAF compared to women (2.34±0.53 AU vs. 2.11±0.50 AU, p < 0.001). Subjects with below -2.5 femoral neck or lumbar T scores had higher SAF measurements compared to subjects with normal T scores (2.46±0.53 AU vs. 2.18±0.52 AU, p = 0.006). Femoral neck BMD was lower in subjects with T2DM (0.946±0.345 g/cm vs. 1.005±0.298 g/cm, p = 0.002). There was a negative correlation between SAF and femoral neck BMD (r=-0.24, p < 0.001), femoral neck T scores (r=-0.24, p < 0.001), L1-4 BMD (r=-0.10, p = 0.005), L1-4 T score (r=-0.16, p=0.001) and a positive correlation between SAF and age (r=0.44, p < 0.001), body mass index (r:0.16, p = 0.002) and HbA1c (r=0.37, p < 0.001). Accumulation of skin AGEs was increased, and BMD levels were decreased in diabetic patients. A negative association between SAF and BMD was detected, indicating a relationship between higher AGE accumulation and low BMD and osteoporosis in diabetic patients. Long-term prospective studies are needed to identify the practical use of SAF measurement in diabetic bone disease.
虽然 2 型糖尿病（T2DM）患者骨折风险增加，但骨密度（BMD）却增加而非减少。晚期糖基化终产物（AGEs）的积累会对 T2DM 患者的骨骼抗骨折能力产生不利影响。我们假设 SAF 也与 2 型糖尿病患者的 BMD 水平有关，并旨在评估 SAF 与 BMD 和骨质疏松症的存在之间的关系。这项横断面病例对照研究纳入了 237 名 T2DM 患者（男/女：133/104，56.2±11.9 岁）和 100 名年龄和性别匹配的对照组（男/女：70/30，54.8±8.8 岁）。皮肤 autofluorescence（SAF）是一种经过验证的非侵入性组织 AGEs 测量方法，使用 AGE Reader（DiagnOptics B.V.，荷兰格罗宁根）检测皮肤胶原中 AGEs 的积累。此外，还使用 DEXA（Lunar DPX-L）测量 BMD。与对照组相比，T2DM 患者的 SAF 值更高（2.21±0.53 AU 与 1.79±0.33 AU，p<0.001）。男性的 SAF 值高于女性（2.34±0.53 AU 与 2.11±0.50 AU，p<0.001）。股骨颈或腰椎 T 评分低于-2.5 的患者的 SAF 测量值高于 T 评分正常的患者（2.46±0.53 AU 与 2.18±0.52 AU，p=0.006）。T2DM 患者的股骨颈 BMD 较低（0.946±0.345 g/cm 与 1.005±0.298 g/cm，p=0.002）。SAF 与股骨颈 BMD（r=-0.24，p<0.001）、股骨颈 T 评分（r=-0.24，p<0.001）、L1-4 BMD（r=-0.10，p=0.005）、L1-4 T 评分（r=-0.16，p=0.001）呈负相关，与年龄（r=0.44，p<0.001）、体重指数（r：0.16，p=0.002）和糖化血红蛋白（r=0.37，p<0.001）呈正相关。糖尿病患者皮肤 AGEs 的积累增加，BMD 水平降低。SAF 与 BMD 之间存在负相关，表明在糖尿病患者中，较高的 AGE 积累与低 BMD 和骨质疏松症之间存在关系。需要进行长期前瞻性研究，以确定 SAF 测量在糖尿病性骨病中的实际应用。
