通过 DXA 和 HR-pQCT 评估 1 型和 2 型糖尿病患者的骨参数 - 一项横断面研究：DIAFALL 研究。

Bone parameters in T1D and T2D assessed by DXA and HR-pQCT - A cross-sectional study: The DIAFALL study.

机构信息

Steno Diabetes Center North Denmark, Aalborg University Hospital, Denmark; Department of Endocrinology, Aalborg University Hospital, Denmark.

Department of Endocrinology, Aalborg University Hospital, Denmark.

出版信息

Bone. 2023 Jul;172:116753. doi: 10.1016/j.bone.2023.116753. Epub 2023 Mar 29.

DOI:10.1016/j.bone.2023.116753

PMID:37001628

Abstract

INTRODUCTION/AIM: People with type 1 diabetes (T1D) and type 2 diabetes (T2D) have an increased risk of fractures due to skeletal fragility. We aimed to compare areal bone mineral density (aBMD), volumetric BMD (vBMD), cortical and trabecular measures, and bone strength parameters in participants with diabetes vs. controls.

METHODS

In a cross-sectional study, we included adult participants with T1D (n = 111, MA = 52.9 years), T2D (n = 106, MA = 62.1 years) and controls (n = 328, MA = 57.7 years). The study comprised of DXA scans and HR-pQCT scans, biochemistry, handgrip strength (HGS), Timed Up and GO (TUG), vibration perception threshold (VPT), questionnaires, medical histories, alcohol use, and previous fractures. Group comparisons were performed after adjustment for sex, age, BMI, diabetes duration, HbA1c, alcohol, smoking, previous fractures, postmenopausal, HGS, TUG, and VPT.

RESULTS

We found decreased aBMD in participants with T1D at the femoral neck (p = 0.028), whereas T2D had significantly higher aBMD at peripheral sites (legs, arms, p < 0.01) vs. controls. In T1D we found higher vBMD (p < 0.001), cortical vBMD (p < 0.001), cortical area (p = 0.002) and thickness (p < 0.001), lower cortical porosity(p = 0.008), higher stiffness (p = 0.002) and failure load (p = 0.003) at radius and higher vBMD (p = 0.003), cortical vBMD(p < 0.001), bone stiffness (p = 0.023) and failure load(p = 0.044) at the tibia than controls. In T2D we found higher vBMD (p < 0.001), cortical vBMD (p < 0.001), trabecular vBMD (p < 0.001), cortical area (p < 0.001) and thickness (p < 0.001), trabecular number (p = 0.024), lower separation (p = 0.010), higher stiffness (p < 0.001) and failure load (p < 0.001) at the radius and higher total vBMD (p < 0.001), cortical vBMD (p < 0.011), trabecular vBMD (p = 0.001), cortical area (p = 0.002) and thickness (p = 0.021), lower trabecular separation (p = 0.039), higher stiffness (p < 0.001) and failure load (p = 0.034) at tibia compared with controls.

CONCLUSION

aBMD measures were as expected lower in T1D and higher in T2D than controls. Favorable bone microarchitecture and strength parameters were seen at the tibia and radius for T1D and T2D.

摘要

介绍/目的：1 型糖尿病（T1D）和 2 型糖尿病（T2D）患者由于骨骼脆弱，骨折风险增加。我们旨在比较糖尿病患者与对照组之间的面积骨密度（aBMD）、容积骨密度（vBMD）、皮质和小梁测量值以及骨强度参数。

方法

在一项横断面研究中，我们纳入了 111 名成年 T1D 患者（MA=52.9 岁）、106 名 T2D 患者（MA=62.1 岁）和 328 名对照组（MA=57.7 岁）。该研究包括 DXA 扫描和 HR-pQCT 扫描、生物化学、握力（HGS）、计时起立行走（TUG）、振动感觉阈值（VPT）、问卷调查、病史、酒精使用情况和既往骨折情况。在调整性别、年龄、BMI、糖尿病病程、HbA1c、酒精、吸烟、既往骨折、绝经后、HGS、TUG 和 VPT 后，对各组进行比较。

结果

我们发现 T1D 患者的股骨颈 aBMD 降低（p=0.028），而 T2D 患者的外周部位（腿部、手臂，p<0.01）的 aBMD 明显高于对照组。在 T1D 中，我们发现 vBMD 较高（p<0.001）、皮质 vBMD 较高（p<0.001）、皮质面积较大（p=0.002）、皮质厚度较厚（p<0.001）、皮质孔隙率较低（p=0.008）、刚度较高（p=0.002）和断裂负荷较高（p=0.003）在桡骨和 vBMD 较高（p=0.003）、皮质 vBMD（p<0.001）、骨刚度（p=0.023）和断裂负荷（p=0.044）在胫骨均高于对照组。在 T2D 中，我们发现 vBMD 较高（p<0.001）、皮质 vBMD 较高（p<0.001）、小梁 vBMD 较高（p<0.001）、皮质面积较大（p<0.001）和厚度较厚（p<0.001）、小梁数量较多（p=0.024）、分离较少（p=0.010）、刚度较高（p<0.001）和断裂负荷较高（p<0.001）在桡骨和总 vBMD 较高（p<0.001）、皮质 vBMD（p<0.011）、小梁 vBMD（p=0.001）、皮质面积较大（p=0.002）和厚度较厚（p=0.021）、小梁分离较少（p=0.039）、刚度较高（p<0.001）和断裂负荷较高（p=0.034）在胫骨均高于对照组。