中国骨质疏松杂志

50岁以上男性T2DM患者骨骼肌质量与骨代谢标志物、骨密度的关系

The relationship between skeletal muscle mass and bone metabolic markers and bone mineral density in male patients with T2DM over 50 years old

DOI：10.3969/j.issn.1006-7108.2024.12.007

中文关键词: 2型糖尿病骨骼肌质量指数骨代谢标志物骨密度骨质疏松

英文关键词:type 2 diabetes skeletal muscle mass index bone metabolic markers bone mass density osteoporosis

基金项目:国家自然科学基金（81960155）；甘肃省自然科学基金（20JR10RA690）；兰州大学第一医院基金（ldyyyn2020-01）

作者	单位
昝晓晖1 陈重阳1 赵阳婷1 李凯1 王亚雯1 郭馨远1 韩梅1 马邓荣1 刘靖芳1,2⁕	1.兰州大学第一临床医学院，甘肃兰州730000 2.兰州大学第一医院内分泌科，甘肃兰州730000

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中文摘要:

目的分析50岁以上男性2型糖尿病患者骨骼肌质量指数与骨代谢标志物、骨密度的相关性。方法选取2022年1月至2023年4月兰州大学第一医院内分泌科住院的398例年龄≥50岁的男性T2DM患者，根据ASMI水平分为肌肉质量减少组（n=181）和肌肉质量正常组（n=217），比较两组患者血清骨代谢标志物骨钙素( osteocalcin，OC)、β-胶原特殊序列（type I collagen carboxyl-terminal peptide β，β-CTX）、I型胶原氨基端肽(type Ⅰ procollagen amino-terminal Peptide，PINP)、股骨颈、全髋、腰椎1~4（L1~4）BMD水平的差异，Pearson/Spearman 相关性及Logistic回归分析ASMI与BMD之间的相关性。结果与肌肉质量正常组相比，肌肉质量减少组骨量减少/骨质疏松患病率显著增高[19（8.8 %）vs 36（19.9 %），P=0.001]，股骨颈、全髋、L1~4 BMD水平显著降低（P＜0.05）。股骨颈、全髋、L1~4 BMD水平与OC、PIPN、β-CTx均呈负相关（P＜0.05），与ASMI呈正相关（P＜0.05）。以是否存在骨量减少/骨质疏松症为因变量，ASMI作为自变量，调整混杂因素后，ASMI与骨量减少/骨质疏松症的发病风险独立负相关[OR=0.540，9 5%CI（0.306~0.953），P＜0.05]，而β-CTx与骨量减少/骨质疏松症的发病风险独立正相关[OR=1.002，95 %CI（1.000~1.004），P＜0.05]。结论 50岁以上男性T2DM患者骨骼肌质量减少、高β-CTx水平与骨量减少/骨质疏松的发生显著相关。

英文摘要:

Objective To analyze the relationship between Appendicular skeletal muscle mass index (ASMI) and bone metabolism markers, bone mineral density (BMD) in male patients with type 2 diabetes over 50 years old. Methods A total of 398 male patients with type 2 diabetes mellitus who were 50 years of age or older and were admitted to the Department of Endocrinology at the First Hospital of Lanzhou University between January 2022 and April 2023 were included in the study, and were categorized into a reduced muscle mass group (n=181) and a normal muscle mass group (n=217) based on their ASMI levels. A comparison was made between the serum bone metabolism markers osteocalcin (OC), β-collagen specific sequence (Type I collagen carboxyl-terminal peptide β, β-CTX), and Type I collagen amino-terminal peptide (PINP) levels of patients in two groups. Additionally, the BMD levels of the femoral neck, hip, lumbar vertebrae 1-4 (L1-4) were compared. Pearson/Spearman correlation and logistic regression were used to analyze correlations between ASMI and BMD. Results The study found a significantly higher prevalence of osteopenia/osteoporosis in the group with reduced muscle mass compared to the group with normal muscle mass (19 [8.8%] vs. 36 [19.9%], P=0.001). Additionally, the group with reduced muscle mass exhibited significantly lower BMD levels in the femoral neck, hip and L1-4 areas (P<0.05). Femoral neck, hip, L1-4 BMD levels were negatively correlated with OC, PIPN, and β-CTx (P < 0.05) and positively correlated with ASMI (P < 0.05). After adjusting for confounders, ASMI was found to be independently and negatively associated with the risk of developing osteopenia/osteoporosis [OR=0.540，95%CI（0.306, 0.953）, P<0.05], while β-CTx was independently and positively associated with the risk of developing osteopenia/osteoporosis [OR=1.002, 95% CI (1.000, 1.004), P<0.05]. Conclusions In male T2DM patients over 50 years old，a reduction in skeletal muscle mass and elevated levels of β-CTx are identified as significantly associated with the development of osteopenia /osteoporosis.

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