糖尿病與骨質疏鬆症

Diabetes and Osteoporosis

郭仁富(Jeng-Fu Kuo) ； 杜思德(Shih-Te Tu)

《內科學誌》 22卷4期 (2011/08) Pp. 243-253

https://doi.org/10.6314/JIMT.2011.22(4).03

摘要

隨著高齡人口的增加和生活型態的改變，糖尿病和骨質疏鬆症已是國內的重要流行病。越來越多的研究證實糖尿病和骨質疏鬆症之間的關聯性。糖尿病患者有較高的骨折風險，但確切的機轉目前仍沒有定論。骨骼生成不足或骨骼代謝轉換減少、骨骼結構的改變、視網膜病變和神經病變增加跌倒的風險、降血糖藥物的使用（如thiazolidinediones）都可能是原因之一。中軸型的雙能量X光吸收儀(dual energy X-ray absorptiometry, DXA)測量的骨質密度是目前骨質疏鬆症的診斷依據，但骨質密度在糖尿病患者無法完整預估骨折風險，搭配fracture risk assessment tool (FRAX)可以補DXA的不足。充分之鈣質和維生素D的攝取、規律的運動、適當的血糖控制可以降低骨折的風險。雖然證據有限，骨鬆藥物(bisphosphonates、raloxifen)降低骨折風險的效果在糖尿病患者似乎是沒有差異，在第1型或第2型糖尿病患者亦沒有差別。

關鍵字

糖尿病 ； 骨質疏鬆症 ； 雙能量X光吸收測量儀

並列摘要

Diabetes and osteoporosis have becomed endemic in Taiwan as a result of the increasing aging population and Western lifestyle. More and more studies proved the relationship between diabetes and osteoporosis. Diabetes is associated with an increased risk of fractures though the pathophysiological mechanisms are still controversial. Decrease in bone formation or bone turnover, altered bone composition, diabetic retinopathy and neuropathy are all related to the risk of osteoporosis and falls. Hypoglycemic drugs such as thiazolidinediones may further increase the excessive risk. Measurements of bone mineral density with dual energy X-ray absorptiometry may underestimate the risk of fracture in the diabetics. Fracture Risk Assessment Tool may make up the shortage of BMD-based prediction of fracture risk. Adequate calcium and vitamine D intake, regular exercise, appropriate glycemic control can decrease the risk of fracture. Although the datas are limited, diabetes does not seem to affect the anti-fracture effectiveness of bisphosphonates or raloxifene.

並列關鍵字

Diabetes ； Osteoporosis ； Dual energy X-ray absorptiometry, DXA