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  • 宋利格.2型糖尿病患者骨折风险升高的机制[J].同济大学学报(医学版),2020,41(4):405-410.    [点击复制]
  • SONG Li-ge.Mechanisms of increased fracture risk in patients with type 2 diabetes mellitus[J].同济大学学报(医学版),2020,41(4):405-410.   [点击复制]
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2型糖尿病患者骨折风险升高的机制
宋利格
0
(同济大学附属同济医院内分泌代谢科,上海 200065; 同济大学医学院骨质疏松与代谢性骨病研究所,上海 200065)
摘要:
2型糖尿病患者的骨折发生风险较非糖尿病人群升高,但其骨密度与非糖尿病人群相比可升高或不变,因此2型糖尿病患者的高骨折发生风险主要由骨质量下降引起。引起2型糖尿病患者骨转换异常致骨折风险升高的机制包括血糖升高、晚期糖基化终末产物增加、胰岛素水平降低或作用缺陷、胰岛素样生长因子1水平降低、氧化应激和促炎细胞因子增加等,从而引起成骨细胞和破骨细胞功能异常、骨折发生风险增加。另外,某些降糖药物的应用也可导致骨折风险增加,如胰岛素、噻唑烷二酮类、钠-葡萄糖协同转运蛋白2抑制剂(sodium-dependent glucose transporters 2 inhibitors, SGLT-2i)。此外,2型糖尿病患者因低血糖发作、糖尿病慢性并发症或肌肉功能减退所引起的跌倒风险增加也可增加骨折的发生风险。
关键词:  2型糖尿病  骨折  骨密度  骨质量  跌倒风险
DOI:10.16118/j.1008-0392.2020.04.001
投稿时间:2020-02-13
基金项目:上海市自然科学基金面上项目(19ZR1448600);上海市卫生和计划生育委员会临床研究专项(201840217);上海申康医院发展中心临床科技创新项目(SHDC12018X10);同济医院临床培育项目(ITJ(ZD)1904)
Mechanisms of increased fracture risk in patients with type 2 diabetes mellitus
SONG Li-ge
(Dept. of Endocrinology, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China; Institute of Osteoporosis and Metabolic Bone Diseases, Tongji University School of Medicine, Shanghai 200065, China)
Abstract:
Fracture risk in the patients with type 2 diabetes mellitus(T2DM) is higher than the non-diabetic population, however, bone mineral density(BMD) in T2DM patients is higher or equal to that of non-diabetic population. Thus, the increased fracture risk in T2DM patients may induced by the impaired bone quality. Data have shown that the increased fracture risk in T2DM patients can be contributed by hyperglycemia, increased advanced glycation end products, decreased insulin concentration or defects of insulin function, decreased insulin-like growth factor-1 level, increased oxidative stress and improper secretion of proinflammatory cytokines. These pathophysiological factors in T2DM patients may induce the imbalance of osteoblast and osteoclast function leading to increase of fracture risk. Moreover, several types of antidiabetic drugs can also increase the fracture risk, such as insulin, thiazolidinediones(TZDs) and sodium-dependent glucose transporters 2 inhibitors(SGLT-2i). In addition, increased risk of fall induced by hypoglycemia, chronic diabetic complications and muscle dysfunction may also contribute to fractures in patients with type 2 diabetes.
Key words:  type 2 diabetes mellitus  fracture  bone mineral density  bone quality  fall risk

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