Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
JAMA Netw Open. 2024 Aug 1;7(8):e2425106. doi: 10.1001/jamanetworkopen.2024.25106.
The reasons for the increased fracture risk in type 2 diabetes (T2D) are not fully understood.
To determine if poorer skeletal characteristics or worse physical function explain the increased fracture risk in T2D.
DESIGN, SETTING, AND PARTICIPANTS: This prospective observational study is based on the population-based Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone Fractures study cohort of older women, performed in the Gothenburg area between March 2013 and May 2016. Follow-up of incident fracture data was completed in March 2023. Data analysis was performed between June and December 2023.
Data were collected from questionnaires and through examination of anthropometrics, physical function, and bone measurements using bone densitometry (dual-energy x-ray absorptiometry), and high-resolution peripheral computed tomography. A subsample underwent bone microindentation to assess bone material strength index (BMSi).
Baseline assessment of bone characteristics and physical function and radiograph verified incident fractures.
Of 3008 women aged 75 to 80 years, 294 women with T2D (mean [SD] age, 77.8 [1.7] years) were compared with 2714 women without diabetes (mean [SD] age, 77.8 [1.6] years). Women with T2D had higher bone mineral density (BMD) at all sites (total hip, 4.4% higher; femoral neck (FN), 4.9% higher; and lumbar spine, 5.2% higher) than women without. At the tibia, women with T2D had 7.4% greater cortical area and 1.3% greater density, as well as 8.7% higher trabecular bone volume fraction. There was no difference in BMSi (T2D mean [SD], 78.0 [8.3] vs controls, 78.1 [7.3]). Women with T2D had lower performance on all physical function tests. The study found 9.7% lower grip strength, 9.9% slower gait speed, and 13.9% slower timed up-and-go time than women without diabetes. During a median (IQR) follow-up of 7.3 (4.4-8.4) years, 1071 incident fractures, 853 major osteoporotic fractures (MOF), and 232 hip fractures occurred. In adjusted (for age, body mass index, clinical risk factors, and FN BMD) Cox regression models, T2D was associated with an increased risk of any fracture (HR, 1.26; 95% CI, 1.04-1.54) and MOF (HR, 1.25; 95% CI, 1.00-1.56).
In this cohort study of older women, T2D was associated with higher BMD, better bone microarchitecture, and no different BMSi but poorer physical function, suggesting that poor physical function is the main reason for the increased fracture risk in T2D women.
2 型糖尿病（T2D）患者骨折风险增加的原因尚不完全清楚。
确定骨骼特征较差或身体功能更差是否可以解释 T2D 患者骨折风险增加的原因。
设计、设置和参与者： 本前瞻性观察性研究基于人群为基础的 Sahlgrenska 大学医院风险评估骨折研究队列的老年女性，于 2013 年 3 月至 2016 年 5 月在哥德堡地区进行。通过骨折数据的随访完成于 2023 年 3 月。数据分析于 2023 年 6 月至 12 月进行。
通过问卷调查和骨骼特征和身体功能的检查，使用骨密度仪（双能 X 射线吸收法）和高分辨率外周计算机断层扫描进行数据收集。一个亚组接受了骨微压痕测试以评估骨材料强度指数（BMSi）。
对基线骨特征和身体功能以及经放射学证实的骨折进行评估。
在 3008 名 75 至 80 岁的女性中，294 名患有 T2D（平均[SD]年龄，77.8[1.7]岁）的女性与 2714 名无糖尿病的女性（平均[SD]年龄，77.8[1.6]岁）进行了比较。患有 T2D 的女性在所有部位的骨矿物质密度（BMD）都更高（总髋部，高 4.4%；股骨颈（FN），高 4.9%；和腰椎，高 5.2%）。在胫骨处，患有 T2D 的女性皮质面积大 7.4%，密度大 1.3%，骨小梁体积分数高 8.7%。BMSi 没有差异（T2D 平均[SD]，78.0[8.3]vs 对照组，78.1[7.3]）。患有 T2D 的女性在所有身体功能测试中的表现均较差。研究发现，患有 T2D 的女性握力低 9.7%，步速慢 9.9%，起身时间慢 13.9%。在中位数（IQR）随访 7.3（4.4-8.4）年期间，发生了 1071 例骨折，853 例主要骨质疏松性骨折（MOF）和 232 例髋部骨折。在调整（年龄、体重指数、临床危险因素和 FN BMD）后的 Cox 回归模型中，T2D 与任何骨折（HR，1.26；95%CI，1.04-1.54）和 MOF（HR，1.25；95%CI，1.00-1.56）的风险增加相关。
在这项对老年女性的队列研究中，T2D 与更高的 BMD、更好的骨微结构和相同的 BMSi 但更差的身体功能有关，这表明身体功能差是 T2D 女性骨折风险增加的主要原因。
