探討糖化血色素與空腹血糖對骨質密度與骨折率增加之影響

背景：分析空腹血糖（fasting blood sugar, FBS）濃度與糖化血色素（glycated hemoglobin, HbA1c）對骨質密度（bone mineral density, BMD）與十年骨折風險評估工具（fracture risk assessment tool, FRAX®）的影響。方法：本篇研究利用回溯性研究方式進行分析，收集來自臺灣南部某區域教學醫院，受檢者為於本院預防醫學中心接受健康檢查受檢者，收集時間從2014年6月至2021年12月，收集年齡區間為20～89歲受檢者，排除癌症患者、實驗室數據資料不完整、BMD有任何一個區域部位無法量測，我們即排除不納入本研究。最終收集21,416位受檢者納入本篇研究。將FBS濃度≤100mg/dL訂為正常組，而>100mg/dL訂為異常組，HbA1c≤7%訂為正常組，而>7%訂為異常組。結果：男性8,018位（37.4%），女性13,398（62.6%）；平均年齡，男性57.25±12.01歲，女性56.63±11.13歲（p<0.001），於男、女性兩組間比較（包括：理學檢查［年齡、身高、體重、身體質量指數、臀圍、腰臀比、收縮壓、舒張壓、體脂肪］，過去病史問卷［先前骨折、抽菸、類風溼性關節炎、續發性骨質疏鬆症、每日喝酒3單位］，實驗室數據［飯前血糖、HbA1c、白蛋白、鹼性磷酯酶、血清尿素氮、肌酸酐、腎絲球過濾率］、BMD、T-score與FRAX®，皆達統計差異（p<0.001）。HbA1c正常與異常組相比僅身高（p=0.265）、過去骨折（p=0.966）、類風濕性關節炎（p=0.174）與喝酒（p=0.212）未達統計差異，其他各項皆達統計差異（p<0.050）。FBS正常與異常組相比僅身高（p=0.436）、類風濕性關節炎（p=0.056）、右側股骨頸BMD（p=0.093）和T-score（p=0.793）、左側股骨頸T-score（p=0.229）未達統計差異，其他各項皆達統計差異（p<0.050）。結論：未來當受檢者罹患DM時應開始監測BMD，避免因疾病造成脆性骨折的發生，也可能改變骨細胞的功能，DM患者維持穩定的血糖對於改善BMD與FRAX®也有一定的幫助。

關鍵字

骨質密度；骨折風險評估工具；飯前血糖；糖化血色素

並列摘要

Background: We aimed to study the effect of fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) on bone mineral density (BMD) and fracture risk assessment tool (FRAX®). Methods: This study used a retrospective research method for analysis and collected the subjects receiving health examinations at the preventive medicine center from a regional teaching hospital in southern Taiwan. The collection time of date was from June 2014 to December 2021. The age ranged 20-89 years. We excluded the cancer patients, incomplete laboratory data, and any region of BMD being unable to be measured from this study. Finally, 21,416 subjects were collected and included in this study. The FBS concentration was divided into ≤ 100 mg/ dL (normal group) and > 100 mg/dL (abnormal group). HbA1c was divided into HbA1c ≤ 7% (normal group) and > 7% (abnormal group). Results: 8,018 males (37.4%), 13,398 females (62.6%); mean age, males 57.25 ± 12.01 years, females 56.63 ± 11.13 years (p < 0.001). Compared between male and female groups (including: physical examination [age, height, weight, body mass index, waist circumference, waist to hip ratio, systolic blood pressure, diastolic blood pressure, body fat], past history questionnaire [previous fracture, current smoking, rheumatoid arthritis, secondary osteoporosis, alcohol 3 or more units/day], laboratory data [FBS, HbA1c, albumin, alkaline phosphatase, blood urea nitrogen, creatinine, estimated glomerular filtration rate], BMD, T-score, and FRAX®), all parameters showed statistical differences (p < 0.001). Normal and abnormal groups of HbA1c were compared, and only height (p = 0.265), previous fractures (p = 0.966), rheumatoid arthritis (p = 0.174) and alcohol 3 or more units/day (p = 0.212) were not statistically different; all other parameters were statistically different (p < 0.050). Normal and abnormal groups of FBS were compared only height (p = 0.436), rheumatoid arthritis (p = 0.056), right femoral neck BMD (p = 0.093), and T-score (p = 0.793), left femoral neck T-score (p = 0.229) not statistical differences. All other parameters were statistically different (p < 0.050). Conclusions: In the future, when subjects suffer from DM, BMD should be monitored to avoid fragility fractures caused by the disease, as they may also change the function of bone cells. Maintaining stable blood sugar in DM patients is also helpful for improving BMD and FRAX®.

並列關鍵字

bone mineral density ； glycated hemoglobin ； fasting blood sugar ； fracture risk assessment tool

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