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目的:分析2型糖尿病(T2DM)对绝经后妇女骨质疏松性骨折风险的影响,为骨质疏松性骨折的预防和干预提供参考。方法:采用前瞻性研究方法,140例绝经后T2DM患者作为暴露队列,同期140例健康绝经后妇女作为对照,进入队列前收集一般资料,检测密度(BMD)、骨转化指标,随访5年中骨折发生情况,5年后再次检测BMD、骨转化指标,并比较各指标差异,生存分析T2DM对骨质疏松性骨折风险的影响。结果:进入队列前,除血糖指标外其他指标组间无显著差异,5年后T2DM组腰椎BMD、股骨颈BMD、P1NP显著下降,且显著低于非T2DM组(P<0.05),骨质疏松41例(30.4%),显著高于非T2DM组(P<0.05);5年随访期内,T2DM组骨折18人次(13.9%),高于对照组8人次(5.8%),差异有统计学意义(P<0.05);Cox回归分析T2DM组无骨折生存率低于对照组(P<0.05)。结论:合并T2DM会增加绝经后妇女骨质疏松性骨折风险,相关机制可能为抑制骨形成转化、降低BMD,应采取措施积极加强预防和干预。
Objective: To analyze the effect of type 2 diabetes mellitus (T2DM) on the risk of osteoporotic fracture in postmenopausal women and provide reference for the prevention and intervention of osteoporotic fracture. METHODS: A prospective study was conducted in 140 postmenopausal T2DM patients as an exposure cohort and 140 healthy postmenopausal women as controls. Prior to entering the cohort, general data, BMD, and bone turnover indices were collected and followed up for 5 years Five years later, the indexes of BMD and bone turnover were detected again. The differences of each index were compared. The survival effect of T2DM on the risk of osteoporotic fracture was analyzed. Results: Before entering the cohort, there was no significant difference between the other index groups except for the blood glucose index. After 5 years, the lumbar spine BMD, femoral neck BMD and P1NP in T2DM group were significantly lower than those in non-T2DM group (P <0.05) 41 cases (30.4%) were significantly higher than those in non-T2DM group (P <0.05). In the 5-year follow-up period, 18 cases (13.9%) were fractured in T2DM group compared with 8 cases in control group (5.8% (P <0.05). The Cox regression analysis showed that the fracture-free survival rate of T2DM group was lower than that of the control group (P <0.05). Conclusions: Combination of T2DM can increase the risk of osteoporotic fracture in postmenopausal women. The related mechanism may be to inhibit bone formation and reduce BMD. Measures should be taken to actively strengthen prevention and intervention.