老年男性2型糖尿病患者骨质疏松相关因素分析

目的 探讨与老年男性2型糖尿病（type 2 diabetes mellitus，T2DM）骨质疏松（osteoporosis，OP）发生相关的因素。方法 选取老年男性T2DM患者288例，根据OP诊断标准分为骨量正常组（72例）、骨量减少组（118例）和骨质疏松组（98例）。测量身高、体重，计算体质指数（body mass index，BMI）；测定空腹血糖（fasting blood glucose，FBG）、糖化血红蛋白（glycosylated hemoglobinA1c，HbA1c）、甲状旁腺素（parathyroid hormone，PTH）、血清钙（serum calcium，Ca）、血清磷（serum phosphonium，P）、25羟维生素D （serum 25-hydroxyvitamin D，25-OH-VD）及尿白蛋白/肌酐（urinary albumin/creatinine ratio，ACR），记录患者病程、降糖药物使用和糖尿病慢性并发症情况。结果 与骨量正常组比较，骨质疏松组和骨量减少组病程较长和HbA1c较高，BMI减低，差异均有统计学意义（均有P<0.05）。相关分析显示股骨颈、三角区、大转子、腰椎（lumbar vertebrae，L）2-4节骨密度（bone mineral density，BMD）与BMI均呈正相关（均有P<0.05），但与HbA1C均呈负相关（均有P<0.05）。骨质疏松组糖尿病肾病、糖尿病视网膜病变发生率均高于骨量正常组、骨量减少组（均有P<0.05）；骨质疏松组糖尿病神经病变发生率高于骨量正常组（χ²=6.168，P=0.013）。Logistic回归分析显示BMI、HbA1c及糖尿病肾病与糖尿病骨质疏松发生相关（均有P<0.05）。结论 低BMI，血糖控制不佳和糖尿病肾病是老年男性T2DM患者OP发生的危险因素。

Investigation of the correlative factors for osteoporosis among elderly male patients with type 2 diabetes

Objective To explore the related factors for osteoporosis(OP) among elderly male patients with type 2 diabetes(T2DM).Methods A total of 288 elderly male patients with T2DM were divided into 3 groups according to the diagnosis standards of OP:normal group (n =72),ostepenia group (n =118) and osteoporosis group (n =98).Body height,weight were measured and body mass index(BMI) was calculated.Fasting blood glucose(FBG),glycosylated hemoglobinA1 c (HbA1 c),parathyroid hormone(PTH),serum calcium(Ca),serum phosphonium(P),serum 25-hydroxyvitamin D(25-OH-VD) and urinary albumin/creatinine ratio(ACR) were detected.Diabetic course,diabetes specific therapy and diabetic chronic complications were recorded.Results Compared with normal group,ostepenia and osteoporosis groups had longer diabetic course,higher HbA1c levels,and lower BMI (all P ＜0.05).Correlation analysis showed that bone mineral density (BMD) value of femoral neck,Ward's triangle region,greater trochanter and lumbar spine L2-4 were positively correlated with BMI (all P ＜ 0.05),but negatively correlated with HbAI c (all P ＜ 0.05).The incidences of diabetic nephropathy,diabetic retinopathy were higher in osteoporosis group than in normal and ostepenia groups (all P ＜ 0.05),and the incidence of diabetic neuropathy was higher in osteoporosis group than in normal group (x2 =6.168,P =0.013).Logistic regression analysis showed that BMI,HbA1c and diabetic nephropathy were correlated with diabetetic osteoporosis (all P ＜ 0.05).Conclusions Low BMI,poor blood glucose control and diabetic nephropathy were the risk factors for OP in elderly male patients with T2DM.