摘要
目的继发性骨质疏松在原发性骨质疏松病人中很常见。糖尿病为已知继发性骨质疏松病因之一。虽然I型糖尿病和糖尿病性骨质疏松有明确联系,但II型糖尿病对骨质健康的影响颇具争议。方法调查WHI参试者中II型糖尿病与骨质疏松及在不同骨骼部位的骨折的关系。结果对此研究人群一些常见危险因素诸如年龄、种族、体密度指标、是否采用激素替代疗法、既往骨折史与骨质疏松及骨折显著相关。糖尿病女性似具降低的骨质疏松患病危险,但此现象在调节其他危险因素后不再显著[调节前HR=0.78,95%CI(0.61,0.99);调节后HR=0.93,95%CI(0.73,1.19)]。糖尿病对骨折的影响在不同的骨骼部位有所变化。在糖尿病女性中髋部骨折危险显著增加[HR=2.54,95%CI(1.14,5.66)],但未见脊柱骨折危险[HR=1.71,95%CI(0.81,3.60)]及手臂骨折危险[HR=0.92,95%CI(0.48,1.76)]有显著变化。尽管总体骨折危险在糖尿病与非糖尿病女性中,无明显不同[HR=1.37,95%CI(0.89,2.09)],但在随访2 000天后可见,糖尿病患者危险增加两倍并具有统计学意义[HR=2.01,95%CI(1.21,3.35)],提示糖尿病不同阶段的危害不同。结论我们的发现显示II型糖尿病或许与骨质疏松没有明确联系,但其至少特异性增加髋部骨折。此外,总体骨折危险呈时间依赖式增长。
Objective Secondary osteoporosis is very common in patients with primary osteoporosis. Diabetes is a known cause of secondary osteoporosis. While type I diabetes has been clearly linked with diabetic osteoporosis, the effect of type II diabetes on bone health is controversial. Methods In the present study, we investigated the associations between type II diabetes and osteoporosis as well as fractures at different skeletal sites in Women＇s Health Initiative participants. Results Common risk factors such as age, race, BMI, HRT use, and the history of fractures were significantly associated with osteoporosis and fractures in this study population. Diabetic women appeared to have a decreased risk of osteoporosis although it no longer remained significant after adjusting for other risk factors （crude HR=0.78, 95%CI 0.61 to 0.99; adjusted HR=0.93, 95%CI 0.73 to 1.19）. The impact of diabetes on fractures varied at different body sites. There was a significant increase of risk of hip fracture （HR=2.54, 95%CI 1.14 to 5.66）, but not spine fracture （HR=1.71, 95%CI 0.81 to 3.60） and arm fracture （HR=0.92, 95%CI 0.48 to 1.76） among the women with diabetes. Although the overall risk of fractures in diabetic women did not differ significantly from non-diabetic women （HR=1.37, 95%CI 0.89 to 2.09）, the difference had a two-fold increase and was statistically significant after 2,000 days （HR=2.01, 95%CI 1.21 to 3.35）, indicating a different hazard at different stages of diabetes. Conclusion Our findings suggest that type II diabetes may not be clearly associated with osteoporosis, it increases a site-specific fracture risk at least in the hip. In addition, the overall fracture risk appears to increase in a time-dependent manner.
出处
《中国循证医学杂志》
CSCD
2008年第7期517-524,共8页
Chinese Journal of Evidence-based Medicine
关键词
糖尿病
骨质疏松
骨折
相关性分析
Diabetes
Osteoporosis
Fracture
Analysis of correlation
