2 型糖尿病与骨密度：荟萃分析和系统评价。

Type 2 diabetes and bone mineral density: A meta-analysis and systematic review.

机构信息

Hubei University of Chinese Medicine, Wuhan, China.

Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China.

出版信息

Medicine (Baltimore). 2024 Nov 8;103(45):e40468. doi: 10.1097/MD.0000000000040468.

DOI:10.1097/MD.0000000000040468

PMID:39533557

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11557011/

Abstract

BACKGROUND

Type 2 diabetes (T2D), a widespread chronic metabolic disorder, presents frequently in clinical settings. The relationship between T2D and bone mineral density (BMD) has been subject to ongoing investigation, yielding inconclusive results.

METHODS

A systematic literature search was conducted across several databases, including CNKI, VIP, CBM, Wanfang, PubMed, Cochrane Library, and Embase, targeting observational studies that explored the impact of microangiopathy associated with T2D on BMD or bone metabolism. The search spanned from the inception of each database to July 1, 2023. The Newcastle-Ottawa Scale was employed for quality assessment, and RevMan 5.3 software was utilized for data analysis. Stata 14.0 was used for the quantitative evaluation of publication bias regarding outcome measures.

RESULTS

The inclusion criteria were met by 30 observational studies, comprising 6470 participants-3121 with diabetes and 3349 without. The meta-analysis revealed no significant difference in overall BMD between the nondiabetic and T2D groups (mean difference [MD] = -0.07, 95% confidence interval [CI] [-0.17, 0.03], Z = 1.45, P = .15). However, BMD at the lumbar vertebrae was significantly higher in nondiabetic individuals compared with those with T2D (MD = -0.14, 95% CI [-0.22, -0.06], Z = 3.32, P = 0.0009), as was the case with femoral neck BMD (MD = -0.11, 95% CI [-0.18, -0.04], Z = 3.08, P = .002). A difference in femoral neck BMD between nondiabetics and individuals with T2D approached but did not reach statistical significance (MD = -0.14, 95% CI [-0.27, 0.00], Z = 1.94, P = .05). An inverted funnel plot analysis suggested possible publication bias, as evidenced by an asymmetrical distribution of studies around the axis of symmetry, with overlap observed in several cases.

CONCLUSION

The findings indicate a significant association between T2D and reduced BMD at critical sites such as the lumbar vertebrae and femoral neck, highlighting an increased risk of osteoporosis or osteoporotic fractures in these regions.

摘要

背景

2 型糖尿病（T2D）是一种常见的慢性代谢性疾病，经常出现在临床环境中。T2D 与骨密度（BMD）之间的关系一直是研究的热点，但结果尚无定论。

方法

我们对多个数据库（包括中国知网、维普、中国生物医学文献数据库、万方、PubMed、Cochrane 图书馆和 Embase）进行了系统的文献检索，旨在寻找观察性研究，这些研究探讨了与 T2D 相关的微血管病变对 BMD 或骨代谢的影响。检索时间从每个数据库的创建时间到 2023 年 7 月 1 日。我们使用 Newcastle-Ottawa 量表进行质量评估，并使用 RevMan 5.3 软件进行数据分析。我们使用 Stata 14.0 对结局指标的发表偏倚进行定量评估。

结果

共有 30 项观察性研究符合纳入标准，纳入了 6470 名参与者，其中 3121 名为糖尿病患者，3349 名为非糖尿病患者。Meta 分析显示，非糖尿病组和 T2D 组之间的总体 BMD 无显著差异（平均差异[MD] = -0.07，95%置信区间[CI] [-0.17，0.03]，Z = 1.45，P =.15）。然而，与 T2D 组相比，非糖尿病组的腰椎 BMD 显著更高（MD = -0.14，95%CI [-0.22，-0.06]，Z = 3.32，P = 0.0009），股骨颈 BMD 也如此（MD = -0.11，95%CI [-0.18，-0.04]，Z = 3.08，P =.002）。非糖尿病组和 T2D 组的股骨颈 BMD 差异接近但未达到统计学意义（MD = -0.14，95%CI [-0.27，0.00]，Z = 1.94，P =.05）。倒漏斗图分析表明存在可能的发表偏倚，研究在对称轴周围的分布呈不对称，在几个案例中观察到重叠。