Ojo Omorogieva, Onilude Yemi, Brooke Joanne, Apau Victoria, Kazangarare Ivy, Ojo Osarhumwese
School of Health Sciences, Faculty of Education, Health and Human Sciences, University of Greenwich, Avery Hill Campus, London SE9 2UG, UK.
Centre of Social Care, Health, and Related Research, Birmingham City University, Westbourne Rd., Birmingham B15 3TN, UK.
Int J Environ Res Public Health. 2025 Jun 6;22(6):910. doi: 10.3390/ijerph22060910.
There is a significant knowledge gap and limited studies have been carried out to evaluate the effect of type 2 diabetes (T2D) on bone quality and skeletal fragility. Previous reviews have tended to focus primarily on bone mineral density (BMD) as a measure of bone quality. However, BMD does not fully reflect the risk of fracture, cannot distinguish between cortical and trabecular bone, and bone fragility in patients with T2D results not only from alterations in bone mineralisation, but also due to changes in bone microarchitecture. In this regard, assessment tools such as trabecular bone score (TBS) and trabecular microarchitectural parameters could be useful and practical tools for examining bone status in people with T2D.
This review aims to examine the effect of type 2 diabetes on bone quality based on a variety of assessment tools.
The PRISMA checklist and PICOS framework were relied on for this systematic review and meta-analysis. Two researchers conducted the searches from database inception until 24/02/25. Databases including Academic Search Premier, APA PsycArticles, APA PsycInfo, CINAHL Plus with Full Text, MEDLINE, and the Psychology & Behavioral Sciences Collection were searched for relevant articles. The reference lists of articles were also searched. The Review Manager 5.4.1 software was used to carry out the meta-analysis.
Ten studies were included in the systematic review, while nine studies were included in the meta-analysis. Based on the narrative synthesis and meta-analysis, four distinct themes were established: bone mineral density, TBS and trabecular microarchitectural parameters, fracture risk, and body mass index (BMI). The meta-analysis of the effect of T2D on BMD showed that T2D significantly ( < 0.05) increased lumbar spine, total hip, femoral neck, and narrow neck BMD compared with controls. The mean differences (MDs) for the respective parameters were 0.04 (95% CI, 0.03, 0.05, < 0.0001); 0.05 (95% CI, 0.02, 0.08, = 0.002); 0.07 (95% CI, 0.04, 0.10, < 0.0001); and 0.03 (95% CI, 0.01, 0.05, = 0.0005). While there was a significant reduction ( < 0.0001) in the patients with T2D with respect to volumetric BMD, involving two studies and 1037 participants, with an MD of -12.36 (95% CI,-18.15, -6.57, < 0.0001), T2D did not appear to have a significant effect ( > 0.05) on total BMD and area BMD compared to controls. In relation to TBS and trabecular microarchitectural parameters, the effect of T2D was not significant ( > 0.05) compared with controls. Furthermore, T2D did not have a significant effect ( > 0.05) on the incidence of hip fracture and non-spine fracture compared to controls. Following meta-analysis, it was found that the T2D significantly ( < 0.05) increased BMI compared to controls with an MD of 0.94 (95% CI, 0.74, 1.14, < 0.0001).
Type 2 diabetes significantly increased ( < 0.05) lumbar spine, total hip, femoral neck, narrow neck BMD, and body mass index compared with controls. However, type 2 diabetes did not appear to have a significant effect ( > 0.05) on TBS, trabecular microarchitectural parameters, and the incidence of hip and non-spine fracture.
存在显著的知识空白，且针对2型糖尿病（T2D）对骨质量和骨骼脆弱性影响的研究有限。以往的综述主要侧重于将骨密度（BMD）作为骨质量的一项衡量指标。然而，骨密度并不能完全反映骨折风险，无法区分皮质骨和小梁骨，并且T2D患者的骨脆弱性不仅源于骨矿化改变，还归因于骨微结构的变化。在这方面，诸如小梁骨评分（TBS）和小梁微结构参数等评估工具可能是用于检查T2D患者骨状态的有用且实用的工具。
本综述旨在基于多种评估工具研究2型糖尿病对骨质量的影响。
本系统评价和荟萃分析依据PRISMA清单和PICOS框架进行。两名研究人员从数据库建立起至2025年2月24日进行检索。检索了包括学术搜索高级版、美国心理学会心理学文摘、美国心理学会心理学数据库、全文版护理学与健康领域数据库、医学索引数据库以及心理学与行为科学合集在内的数据库以查找相关文章。还检索了文章的参考文献列表。使用Review Manager 5.4.1软件进行荟萃分析。
系统评价纳入了10项研究，荟萃分析纳入了9项研究。基于叙述性综合分析和荟萃分析，确立了四个不同主题：骨密度、TBS和小梁微结构参数、骨折风险以及体重指数（BMI）。T2D对骨密度影响的荟萃分析表明，与对照组相比，T2D显著（P<0.05）增加了腰椎、全髋、股骨颈和窄颈的骨密度。各参数的平均差值（MDs）分别为0.04（95%置信区间，0.03，0.05，P<0.0001）；0.05（95%置信区间，0.02，0.08，P = 0.002）；0.07（95%置信区间，0.04，0.10，P<0.0001）；以及0.03（95%置信区间，0.01，0.05，P = 0.0005）。虽然在涉及两项研究和1037名参与者的T2D患者中，体积骨密度显著降低（P<0.0001），MD为-12.36（95%置信区间，-18.15，-6.57，P<0.0001），但与对照组相比，T2D对总骨密度和面积骨密度似乎没有显著影响（P>0.05）。关于TBS和小梁微结构参数，与对照组相比，T2D的影响不显著（P>0.05）。此外，与对照组相比，T2D对髋部骨折和非脊柱骨折的发生率没有显著影响（P>0.05）。荟萃分析后发现，与对照组相比，T2D显著（P<0.05）增加了BMI，MD为0.94（95%置信区间，0.74，1.14，P<0.0001）。
与对照组相比，2型糖尿病显著（P<0.05）增加了腰椎、全髋、股骨颈、窄颈骨密度以及体重指数。然而，2型糖尿病似乎对TBS、小梁微结构参数以及髋部和非脊柱骨折的发生率没有显著影响（P>0.05）。
