Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, USA.
Osteoporos Int. 2022 Jun;33(6):1365-1372. doi: 10.1007/s00198-022-06325-x. Epub 2022 Feb 17.
In pre- and early perimenopausal women, prediabetes (with blood glucose ≥ 110 mg/dL) and greater insulin resistance are associated with worse trabecular bone quality (as assessed by trabecular bone score).
Diabetes mellitus (DM) is associated with lower trabecular bone score (TBS) and fracture; less certain is whether the precursor states of prediabetes and increased insulin resistance are also related to adverse bone outcomes. We examined, in women who do not have DM, the associations of glycemic status (prediabetes vs. normal) and insulin resistance with TBS.
This was a cross-sectional analysis of baseline data collected from 42- to 52-year-old, pre- and perimenopausal participants in the Study of Women's Health Across the Nation (SWAN) TBS Study. Women with prediabetes were categorized as having either high prediabetes if their fasting glucose was between 110 and 125 mg/dL or low prediabetes if their fasting glucose was between 100 and 109 mg/dL. Normoglycemia was defined as a fasting glucose below 100 mg/dL.
In multivariable linear regression, adjusted for age, race/ethnicity, menopause transition stage, cigarette use, calcium and vitamin D supplementation, lumbar spine bone mineral density, and study site, women with high prediabetes had 0.21 (p < 0.0001) standard deviations (SD) lower TBS than those with normoglycemia. Low prediabetes was not associated with lower TBS. When HOMA-IR levels were ≥ 1.62, each doubling of HOMA-IR was associated with a 0.11 SD decrement in TBS (p = 0.0001).
Similar to diabetics, high prediabetics have lower TBS than normoglycemic individuals. Women with greater insulin resistance have lower TBS even in the absence of DM. Future studies should examine the associations of high prediabetes and insulin resistance with incident fracture.
糖尿病（DM）与较低的骨小梁评分（TBS）和骨折有关；但尚不清楚前驱状态的糖尿病前期和胰岛素抵抗是否也与不良的骨骼结局有关。我们在没有糖尿病的女性中检查了血糖状况（糖尿病前期与正常）和胰岛素抵抗与 TBS 的关系。
这是一项来自妇女健康研究全国（SWAN）TBS 研究的 42-52 岁绝经前和绝经后参与者的基线数据的横断面分析。高糖尿病前期的女性被归类为空腹血糖在 110 到 125mg/dL 之间，而低糖尿病前期的女性空腹血糖在 100 到 109mg/dL 之间。血糖正常定义为空腹血糖低于 100mg/dL。
在多变量线性回归中，调整了年龄、种族/民族、绝经过渡期、吸烟、钙和维生素 D 补充剂、腰椎骨密度和研究地点后，高糖尿病前期的女性 TBS 比血糖正常的女性低 0.21（p<0.0001）个标准差。低糖尿病前期与较低的 TBS 无关。当 HOMA-IR 水平≥1.62 时，HOMA-IR 每增加一倍，TBS 下降 0.11 个标准差（p=0.0001）。
与糖尿病患者相似，高糖尿病前期患者的 TBS 低于血糖正常者。即使在没有 DM 的情况下，胰岛素抵抗较高的女性 TBS 也较低。未来的研究应该检查高糖尿病前期和胰岛素抵抗与骨折发生率的关系。
