2型糖尿病患者脆性骨折风险增加的机制
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南京医科大学第一附属医院老年医学科

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国家自然科学基金项目(82170898)


Mechanisms of increased risk of fragility fractures in patients with type 2 diabetes mellitus
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the National Natural Science Foundation of China (82170898),

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    摘要:

    2型糖尿病(type 2 diabetes mellitus,T2DM)是以高血糖、胰岛素抵抗为特征的代谢性疾病,易导致多个系统出现并发症,如神经病变、肾病、视网膜病变和骨病等。骨质疏松性骨折具有高发病率、高死亡率和高医疗资源消耗的特点,是重大公共卫生问题。与非糖尿病患者相比,T2DM患者发生脆性骨折的风险增加,尽管患者可能表现为骨密度正常或增加,骨质量受损是该人群骨骼脆性增加的主要原因。了解T2DM相关骨脆性的发病机制有助于有骨折风险的患者进一步检测及治疗。T2DM患者骨骼脆性的机制很复杂,受到多种因素影响,如肥胖、高血糖、胰岛素抵抗、氧化应激、微血管并发症和晚期糖基化终产物的积累等。这些因素可能导致骨代谢、结构和强度的改变。其他因素,如低血糖和随之而来的跌倒倾向增加,以及某些抗糖药物对骨骼和矿物质代谢的直接影响,可能导致该人群的骨折风险增加。本文对这些影响因素作用的机制进行简单综述。

    Abstract:

    Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by hyperglycemia and insulin resistance, often leading to complications across multiple systems, including neuropathy, nephropathy, retinopathy, and bone diseases. Osteoporotic fractures are particularly concerning public health issues due to their high incidence, significant mortality rates, and substantial consumption of medical resources. Compared to non-diabetic individuals, patients with T2DM have an elevated risk of fragility fractures. Despite often having normal or increased bone density, the primary cause of this increased fracture risk is impaired bone quality. Understanding the pathogenesis of bone fragility associated with T2DM is crucial for improving screening and treatment strategies for patients at risk of fractures.The mechanisms underlying increased bone fragility in T2DM patients are complex and multifactorial, involving obesity, hyperglycemia, insulin resistance, oxidative stress, microvascular complications, and the accumulation of advanced glycation end products. These factors can lead to alterations in bone metabolism, structure, and strength. Additionally, other factors, such as hypoglycemia and the associated increased risk of falls, as well as the direct effects of certain antidiabetic medications on bone and mineral metabolism, may further contribute to the heightened fracture risk in this population. This review provides a concise overview of the mechanisms by which these factors influence bone fragility in patients with T2DM.

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  • 收稿日期:2024-04-22
  • 最后修改日期:2024-06-01
  • 录用日期:2024-10-10
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