Lu Weihong, Zheng Silan, Zhou Jingqi, Huang Shunfa, Chen Ning, Li Zhibin
Department of Gynecology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, People's Republic of China.
Xiamen Clinical Research Center for Cancer Therapy, Xiamen, People's Republic of China.
Diabetes Metab Syndr Obes. 2023 Feb 14;16:457-468. doi: 10.2147/DMSO.S401397. eCollection 2023.
This study aimed to examine associations between plasma sex-related hormones with bone mineral density (BMD) and risks of osteoporosis or osteopenia in men and postmenopausal women patients with type 2 diabetes mellitus (T2DM).
Baseline information on an ongoing cohort of 149 men and 102 postmenopausal women with T2DM in Xiamen, China were analyzed. Plasma estradiol (E2), total testosterone (T), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin (PRL) were measured. BMD of lumbar spine (L2-4), femoral neck (FN) and total hip (TH) were determined by dual-energy X-ray absorptiometry (DXA). Osteoporosis or osteopenia was defined as the minimum T-scores of BMD of these three different sites of -1.0 or below.
T2DM patients with osteoporosis/osteopenia (66.4% in men and 79.4% in postmenopausal women), compared to those without, showed significantly decreased level of E2 (75.3±28.9 vs. 107.8±25.9pmol/L and 18.4 (18.4-29.5) vs. 22.8 (18.4-40.5) pmol/L for men and postmenopausal women, respectively, both p-values <0.05), but not other sex-related hormones (including T, FSH, LH, or PRL). For all T2DM patients together and men separately, multivariable linear regression and logistic regression analyses showed that higher E2 levels were significantly associated with higher BMD T-scores in L2-4, FN, TH and minimum of these three different sites, lower 10-year probability of major osteoporotic fractures (MOF) and hip fractures (HFs) estimated by Fracture Risk Assessment Tool score, as well as decreased risk of osteoporosis/osteopenia. As for postmenopausal women T2DM patients, E2 level was positively associated with BMD T-scores in L2-4 and minimum of three different sites but was not independently associated with risk of osteoporosis/osteopenia.
Higher plasma E2 was significantly associated with increased BMD and lower risk of osteoporosis or osteopenia in T2DM patients, especially for men. Screening of BMD and estradiol levels as well as evaluating risks of osteoporosis/osteopenia are important for T2DM patients.
本研究旨在探讨2型糖尿病（T2DM）男性患者及绝经后女性患者血浆性激素与骨密度（BMD）之间的关联以及骨质疏松或骨质减少的风险。
分析了中国厦门正在进行的一项队列研究中149名男性和102名绝经后女性T2DM患者的基线信息。检测了血浆雌二醇（E2）、总睾酮（T）、促卵泡生成素（FSH）、促黄体生成素（LH）和催乳素（PRL）。采用双能X线吸收法（DXA）测定腰椎（L2-4）、股骨颈（FN）和全髋（TH）的骨密度。骨质疏松或骨质减少定义为这三个不同部位骨密度的最低T值为-1.0或更低。
与无骨质疏松/骨质减少的T2DM患者相比，有骨质疏松/骨质减少的患者（男性为66.4%，绝经后女性为79.4%）E2水平显著降低（男性分别为75.3±28.9与107.8±25.9pmol/L，绝经后女性为18.4（18.4-29.5）与22.8（18.4-40.5）pmol/L，p值均<0.05），但其他性激素（包括T、FSH、LH或PRL）无此变化。对于所有T2DM患者及男性患者单独分析，多变量线性回归和逻辑回归分析显示，较高的E2水平与L2-4椎体、股骨颈、全髋及这三个不同部位最低值的较高骨密度T值显著相关，根据骨折风险评估工具评分估算的主要骨质疏松性骨折（MOF）和髋部骨折（HF）的10年概率较低，以及骨质疏松/骨质减少风险降低。对于绝经后女性T2DM患者，E2水平与L2-4椎体及三个不同部位最低值的骨密度T值呈正相关，但与骨质疏松/骨质减少风险无独立关联。
较高的血浆E2与T2DM患者骨密度增加及骨质疏松或骨质减少风险降低显著相关，尤其是男性。对T2DM患者进行骨密度和雌二醇水平筛查以及评估骨质疏松/骨质减少风险具有重要意义。
