Operative Research Unit of Osteo-Metabolic and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy.
Research Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 21, 00128 Rome, Italy.
J Clin Endocrinol Metab. 2024 Nov 18;109(12):e2283-e2290. doi: 10.1210/clinem/dgae045.
Type 2 diabetes mellitus is associated with more rapid bone loss in women, but less evidence is available for men or those with prediabetes.
To determine whether bone loss rate is affected by diabetes status in older men, we analyzed data from the Osteoporotic Fractures in Men (MrOS) study.
The multisite MrOS study enrolled 5994 men aged ≥ 65 years. Diabetes status was defined by self-report, diabetes medication use, or elevated fasting serum glucose at baseline. Hip bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA) at baseline and a follow-up visit after 4.6 ± 0.4 years. This analysis included 4095 men, excluding those without follow-up DXA or with unknown diabetes status. Changes in hip BMD in participants with normoglycemia (NG), prediabetes, or type 2 diabetes, excluding thiazolidinedione (TZD) users, were evaluated using generalized linear models (GLM). Diabetes medication use and BMD loss among those with type 2 diabetes were also evaluated with GLM.
In adjusted models, hip BMD loss was greater in men with type 2 diabetes (- 2.23%; 95% CI: -2.54 to -1.91; P < .001) but not in men with prediabetes (-1.45%; 95% CI -1.63 to -1.26; P = .33) compared with NG (-1.57%; 95% CI -1.73 to -1.41). Among men with type 2 diabetes, TZD, insulin, and sulfonylurea use were associated with greater hip BMD loss.
Men with type 2 diabetes, but not prediabetes, experienced accelerated bone loss compared to participants with normoglycemia. More rapid bone loss predicts increased risk of fractures and mortality in broader populations.
2 型糖尿病与女性更快的骨质流失有关，但对于男性或糖尿病前期患者的证据较少。
为了确定糖尿病状态是否会影响老年男性的骨质流失率，我们分析了来自男性骨质疏松症（MrOS）研究的数据。
这项多中心 MrOS 研究纳入了 5994 名年龄≥65 岁的男性。糖尿病状态通过自我报告、糖尿病药物使用或基线时空腹血清葡萄糖升高来定义。基线和 4.6±0.4 年后的随访时使用双能 X 射线吸收法（DXA）测量髋部骨密度（BMD）。本分析包括 4095 名没有随访 DXA 或糖尿病状态未知的参与者。使用广义线性模型（GLM）评估血糖正常（NG）、糖尿病前期或 2 型糖尿病（不包括噻唑烷二酮[TZD]使用者）参与者的髋部 BMD 变化。还使用 GLM 评估了 2 型糖尿病患者的糖尿病药物使用和 BMD 丢失情况。
在调整后的模型中，与 NG（-1.57%；95%CI：-1.73 至-1.41）相比，2 型糖尿病男性的髋部 BMD 丢失更大（-2.23%；95%CI：-2.54 至-1.91；P<0.001），但糖尿病前期男性的髋部 BMD 丢失没有差异（-1.45%；95%CI：-1.63 至-1.26；P=0.33）。在 2 型糖尿病男性中，TZD、胰岛素和磺脲类药物的使用与髋部 BMD 丢失更大有关。
与血糖正常的参与者相比，2 型糖尿病男性但非糖尿病前期男性经历了加速的骨质流失。更快的骨质流失预示着更广泛人群骨折和死亡风险的增加。
