Mogos I C, Niculescu D A, Dusceac R, Poiana C
"Carol Davila" University of Medicine and Pharmacy - Endocrinology.
"Prof. Dr. Agrippa Ionescu" Emergency Hospital - Endocrinology.
Acta Endocrinol (Buchar). 2024 Jan-Mar;20(1):27-32. doi: 10.4183/aeb.2024.27. Epub 2024 Oct 3.
Chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) are associated with disturbed mineral homeostasis and serum bone biomarkers. The interplay between T2DM and CKD on serum bone turnover markers (BTM) is unclear. Our aim was to describe the BTM in patients with T2DM, CKD or both.
In this observational, single-centre, prospective study, we included 320 patients over 40 years, divided into four groups: T2DM and normal kidney function (n=142), T2DM and CKD (n=36), CKD and normal glucose metabolism (n=29) and healthy controls (n=113). We excluded patients treated for osteoporosis and with secondary osteoporosis. Patients were compared by age, levels of glycated hemoglobin, PTH, alkaline phosphatase, osteocalcin (OC), CTx and 25 OH vitamin D.
Univariate analysis showed that GFR correlated significantly with PTH (r=0.37), OC (r=0.43) and CTX (r=0.45) in the diabetes group but only with PTH (r=0.34) in the non-T2DM group. Multivariate analysis showed that GFR remained significantly correlated with the same bone markers even after adjustment for age, sex or 25(OH)D levels. Diabetics seem to have lower levels of alkaline phosphatase (68±22.1 U/L) and CTX (0.37±0.24 ng/mL) than those without diabetes (76.7±29.6. U/L and 0.5±0.19 ng/mL, respectively). There was no correlation between BTM and glycated hemoglobin.
Bone turnover markers correlate with GFR, particularly in patients with T2DM. However, alkaline phosphatase is lower in T2DM than in non-T2DM.
慢性肾脏病（CKD）和2型糖尿病（T2DM）与矿物质稳态紊乱及血清骨生物标志物有关。T2DM和CKD对血清骨转换标志物（BTM）的相互作用尚不清楚。我们的目的是描述T2DM、CKD或两者兼有的患者的BTM情况。
在这项观察性、单中心、前瞻性研究中，我们纳入了320名40岁以上的患者，分为四组：T2DM且肾功能正常（n = 142）、T2DM且CKD（n = 36）、CKD且糖代谢正常（n = 29）以及健康对照组（n = 113）。我们排除了接受骨质疏松治疗和患有继发性骨质疏松的患者。通过年龄、糖化血红蛋白、甲状旁腺激素（PTH）、碱性磷酸酶、骨钙素（OC）、I型胶原交联C末端肽（CTx）和25羟维生素D水平对患者进行比较。
单因素分析显示，糖尿病组中肾小球滤过率（GFR）与PTH（r = 0.37）、OC（r = 0.43）和CTX（r = 0.45）显著相关，而非T2DM组中GFR仅与PTH（r = 0.34）相关。多因素分析显示，即使在调整年龄、性别或25（OH）D水平后，GFR仍与相同的骨标志物显著相关。糖尿病患者的碱性磷酸酶（68±22.1 U/L）和CTX（0.37±0.24 ng/mL）水平似乎低于无糖尿病患者（分别为76.7±29.6 U/L和0.5±0.19 ng/mL）。BTM与糖化血红蛋白之间无相关性。
骨转换标志物与GFR相关联，尤其是在T2DM患者中。然而，T2DM患者的碱性磷酸酶水平低于非T2DM患者。
