Sheu Angela, Blank Robert D, Tran Thach, Bliuc Dana, Greenfield Jerry R, White Christopher P, Center Jacqueline R
Skeletal Diseases Program Garvan Institute of Medical Research Sydney NSW Australia.
School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Clinical Campus, Faculty of Medicine and Health UNSW Sydney Sydney NSW Australia.
JBMR Plus. 2023 Jun 8;7(9):e10780. doi: 10.1002/jbm4.10780. eCollection 2023 Sep.
Type 2 diabetes (T2D) may be associated with increased risk of fractures, despite preserved bone mineral density (BMD). Obesity and insulin resistance (IR) may have separate effects on bone turnover and bone strength, which contribute to skeletal fragility. We characterized and assessed the relative associations of obesity, body composition, IR, and T2D on bone turnover markers (BTMs), BMD, and advanced hip analysis (AHA). In this cross-sectional analysis of Dubbo Osteoporosis Epidemiology Study, 525 (61.3% women) participants were grouped according to T2D, IR (homeostasis model assessment insulin resistance [HOMA-IR] </≥2.5), and BMI (</≥25 kg/m): insulin-sensitive lean (IS-L), insulin-sensitive overweight/obese (IS-O), insulin-resistant (IR), and T2D. BMD, AHA, and body composition, including visceral adipose tissue (VAT) (on dual-energy x-ray absorptiometry scan) and fasting BTMs, were assessed. Analyses performed using Bayesian model averaging and principal component analysis. T2D was associated with low BTMs (by 26%-30% [95% confidence interval [CI] 11%-46%] in women, 35% [95% CI 18%-48%] in men compared to IS-L), which persisted after adjustment for VAT. BTMs were similar among IR/IS-O/IS-L. BMD was similar among T2D/IR/IS-O; BMD was low only in IS-L. All groups were similar after adjustment for BMI. Similarly, AHA components were lowest in IS-L (attenuated following adjustment). On multivariate analysis, T2D was independently associated with BTMs. IR was also associated with C-terminal telopeptide of type 1 collagen in men. Age and body size were the strongest independent contributors to BMD and AHA. VAT was inversely associated with section modulus, cross-sectional area, cross-sectional moment of inertia in women, and hip axis length in men. Low bone turnover is associated with T2D and IR (in men), while BMD and hip strength/geometry are predominantly associated with body size. VAT, indicative of dysglycemia, is also associated with impaired bone geometry. Establishing the role of BTMs and AHA fracture risk may improve skeletal assessment in T2D people. © 2023 The Authors. published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
2型糖尿病（T2D）可能与骨折风险增加有关，尽管骨矿物质密度（BMD）保持正常。肥胖和胰岛素抵抗（IR）可能对骨转换和骨强度有独立影响，进而导致骨骼脆弱。我们对肥胖、身体成分、IR和T2D与骨转换标志物（BTMs）、BMD及高级髋部分析（AHA）之间的相对关联进行了特征描述和评估。在这项对达博骨质疏松症流行病学研究的横断面分析中，525名参与者（61.3%为女性）根据T2D、IR（稳态模型评估胰岛素抵抗[HOMA-IR]< /≥2.5）和体重指数（BMI）（< /≥25 kg/m²）进行分组：胰岛素敏感瘦体型（IS-L）、胰岛素敏感超重/肥胖体型（IS-O）、胰岛素抵抗型（IR）和T2D型。评估了BMD、AHA和身体成分，包括内脏脂肪组织（VAT）（通过双能X线吸收法扫描）和空腹BTMs。使用贝叶斯模型平均法和主成分分析法进行分析。与IS-L相比，T2D与低BTMs相关（女性降低26%-30%[95%置信区间（CI）11%-46%]，男性降低35%[95%CI 18%-48%]），在调整VAT后这种关联仍然存在。IR/IS-O/IS-L之间的BTMs相似。T2D/IR/IS-O之间的BMD相似；仅IS-L的BMD较低。调整BMI后所有组相似。同样，AHA各成分在IS-L中最低（调整后减弱）。多变量分析显示，T2D与BTMs独立相关。IR在男性中还与1型胶原C端肽相关。年龄和体型是BMD和AHA最强的独立影响因素。VAT与女性的截面模量、横截面积、截面惯性矩以及男性的髋轴长度呈负相关。低骨转换与T2D和IR（男性）相关，而BMD和髋部强度/几何形状主要与体型相关。VAT提示血糖异常，也与骨几何形状受损有关。明确BTMs和AHA骨折风险的作用可能会改善T2D患者的骨骼评估。© 2023作者。由Wiley Periodicals LLC代表美国骨与矿物质研究学会出版。
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