Bone Mineral Density,Abdominal Adipose and Metabolic Indexes in Type 2 Diabetes Mellitus Patients:a Correlation Analysis
Objective To investigate the correlation between bone mineral density(BMD)and abdominal adipose as well as metabolic indexes in patients with type 2 diabetes mellitus(T2DM).Methods A total of 236 patients with T2DM aged over 40 years who were admitted to the First Affiliated Hospital of Nanchang University from July to December 2020 were selected.Quantitative CT(QCT)was used to measure L1-3 BMD,abdominal visceral fat(AVF),and subcutaneous adipose tissue(SAF)area.Based on BMD values,the patients were divided into 3 groups:the normal bone mass group with 84 cases,the low bone mass group with 109 cases,and the osteoporosis(OP)group with 43 cases.The general information,biochemical indicators,bone metabolism indexes,abdominal fat,and adipocytokines of the 3 groups were compared,and their relationships with BMD were analyzed.Meanwhile,patients were grouped based on body mass index(BMI)and female age to compare differences in BMI,waist-hip ratio(WHR),BMD,AVF,and SAF among all groups.Results Among the 236 T2DM patients,those with normal bone mass,low bone mass,and osteoporosis accounted for 35.59%,46.19%,and 18.22%,respectively;the incidence of OP in women was significantly higher than that in men(P＜0.05).The ages of patients in the low bone mass group were significantly older than those in the normal bone mass group and the OP group(P＜0.05);the disease duration in the OP group was significantly longer than that in the normal bone mass group(P＜0.05);the triglyceride(TG)level in the OP group was significantly lower than that in the normal bone mass group and the low bone mass group(P＜0.05);the levels of β-C-terminal telopeptide of type I collagen(β-CTX)and total procollagen type 1 N-terminal propeptide(TP1NP)in the OP group were significantly higher than those in the normal bone mass group(P＜0.05);the level of 25-hydroxyvitamin D[25(OH)D]in the low bone mass group was significantly higher than that in the normal bone mass group and the OP group(P＜0.05);the level of tumor necrosis factor-α(TNF-α)in the low bone mass group was significantly higher than that in the normal bone mass group(P＜0.05).There were no statistically significant differences in other indexes between the 3 groups(P＞0.05).In the normal weight group of 126 patients,there were 14 cases with AVF＜80 cm2 and 112 cases with AVF≥80 cm2;the values of BMI,WHR,AVF,and SAF in the obesity group were significantly higher than those in the overweight and normal weight groups(P＜0.05);there was no statistically significant difference in BMD between the 3 groups(P＞0.05).The correlation analysis showed that BMD was negatively correlated with age,disease duration,β-CTX,TP1NP,interleukin-1β(IL-1β),interleukin-6(IL-6),and TNF-α(P＜0.05);AVF was positively correlated with age,BMI,WHR,fasting C-peptide(FCP),triglycerides(TG),C-reactive protein(CRP),IL-1β,IL-6,TNF-α,and SAF(P＜0.05),and negatively correlated with high-density lipoprotein cholesterol(HDL-C)(P＜0.05).SAF was positively correlated with BMI,WHR,TG,CRP,TNF-α,AVF,and blood phosphorus(P)(P＜0.05).The multivariate ordinal logistic regression analysis indicated that female gender,age,disease duration,and β-CTX were risk factors for the development of OP in T2DM patients,while P was a protective factor for OP.Conclusion The level of L1-3 BMD in T2DM patients measured by QCT was found to have no correlation with abdominal fat but was negatively correlated with adipocytokines(IL-1β,IL-6,TNF-α),age,disease duration,β-CTX,and TP1NP.Female gender,age,disease duration,and β-CTX were identified as independent risk factors for the development of OP in T2DM patients,whereas a moderate increase in P within the normal reference range might be a beneficial factor in inhibiting the occurrence of OP.AVF had a greater impact on metabolism than SAF,and the accuracy of BMI as a measure of obesity was significantly lower than that of AVF.The use of BMI for diagnosing obesity could lead to missed diagnosis of the majority of patients with normal BMI but excessive visceral fat.
Type 2 diabetes mellitusbone mineral densitybone metabolismabdominal adiposeadipocytokine
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