糖尿病患者骨脆性的生化标志物。国际骨质疏松基金会（IOF）和欧洲钙化组织协会（ECTS）的叙述性综述
Biochemical Markers of Bone Fragility in Patients with Diabetes. A Narrative Review by the IOF and the ECTS.
作者信息
Meier Christian, Eastell Richard, Pierroz Dominique D, Lane Nancy E, Al-Daghri Nasser, Suzuki Atsushi, Napoli Nicola, Mithal Ambrish, Chakhtoura Marlene, El-Hajj Fuleihan Ghada, Ferrari Serge
机构信息
Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Switzerland.
Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK.
出版信息
J Clin Endocrinol Metab. 2023 May 8;108(10):e923-36. doi: 10.1210/clinem/dgad255.
CONTEXT
The risk of fragility fractures is increased in both type 1 and type 2 diabetes. Numerous biochemical markers reflecting bone and/or glucose metabolism have been evaluated in this context. This review summarizes current data on biochemical markers in relation to bone fragility and fracture risk in diabetes.
METHODS
Literature review by a group of experts from the International Osteoporosis Foundation (IOF) and European Calcified Tissue Society (ECTS) focusing on biochemical markers, diabetes, diabetes treatments and bone in adults.
RESULTS
Although bone resorption and bone formation markers are low and poorly predictive of fracture risk in diabetes, osteoporosis drugs seem to change bone turnover markers in diabetics similarly to non-diabetics, with similar reductions in fracture risk. Several other biochemical markers related to bone and glucose metabolism have been correlated with BMD and/or fracture risk in diabetes, including osteocyte-related markers such as sclerostin, HbA1c and advanced glycation end products (AGEs), inflammatory markers and adipokines, as well as IGF-1 and calciotropic hormones.
CONCLUSION
Several biochemical markers and hormonal levels related to bone and/or glucose metabolism have been associated with skeletal parameters in diabetes. Currently, only HbA1c levels seem to provide a reliable estimate of fracture risk, while bone turnover markers could be used to monitor the effects of anti-osteoporosis therapy.
背景
1型和2型糖尿病患者发生脆性骨折的风险均会增加。在此背景下，众多反映骨骼和/或糖代谢的生化标志物已得到评估。本综述总结了目前有关糖尿病患者中与骨脆性和骨折风险相关的生化标志物的数据。
方法
由国际骨质疏松症基金会（IOF）和欧洲钙化组织协会（ECTS）的一组专家进行文献综述，重点关注成人的生化标志物、糖尿病、糖尿病治疗及骨骼。
结果
尽管在糖尿病患者中，骨吸收和骨形成标志物水平较低且对骨折风险的预测性较差，但骨质疏松药物似乎对糖尿病患者骨转换标志物的改变与非糖尿病患者相似，骨折风险降低程度也相似。其他一些与骨和糖代谢相关的生化标志物已与糖尿病患者的骨密度（BMD）和/或骨折风险相关联，包括与骨细胞相关的标志物，如骨硬化蛋白、糖化血红蛋白（HbA1c）和晚期糖基化终末产物（AGEs）、炎症标志物和脂肪因子，以及胰岛素样生长因子-1（IGF-1）和钙调节激素。
结论
一些与骨和/或糖代谢相关的生化标志物及激素水平已与糖尿病患者的骨骼参数相关联。目前，似乎只有HbA1c水平能可靠地评估骨折风险，而骨转换标志物可用于监测抗骨质疏松治疗的效果。
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