摘要
2型糖尿病(type 2 diabetes,T2DM)对骨质量有负面影响,并增加骨折风险。糖尿病患者骨代谢异常的潜在机制可能包括肥胖、高血糖、氧化应激及晚期糖基化终产物积累的影响,导致骨代谢、结构和强度的改变。该文主要对T2DM患者脂肪过度积累导致的脂肪炎症及T2DM相关的肌萎缩探讨T2DM骨代谢异常的可能机制。研究发现,钠-葡萄糖共转运体2抑制剂(sodium-glucose co-transporter 2 inhibitors,SGLT2i)可能间接破坏钙和磷酸盐稳态,加速骨密度(bone mineral density,BMD)下降。该文重点阐述了SGLT2i通过减重影响脂肪分布,维持肌肉质量,减轻脂肪及肌肉的炎症反应,从而间接对T2DM骨代谢障碍产生有益影响的可能机制。另外,肾功能受损和心血管风险升高的老年患者中SGLT2i增加骨折风险可能与渗透利尿继发的跌倒和容量不足有关。
Type 2 diabetes(T2DM)is associated with increased fracture risk.The mechanisms underlying skeletal fragility are multifactorial and likely include obesity,hyperglycaemia,oxidative stress,and accumulation of advanced glycation end products,leading to altered bone metabolism,structure,and strength.This article mainly explores the possible mechanisms of bone metabolism disorder of T2DM,including fat inflammation caused by excessive fat accumulation and T2DM related muscle atrophy.Recently,studies have found that sodium-glucose cotransporter 2 inhibitor(SGLT2i)may cause bone loss or increase fracture risk due to altered calcium,phosphate,and sodium concentration.This review explores that SGLT2i indirectly affects bone metabolism disorder of T2DM by affecting fat distribution,maintaining muscle mass,and reducing the inflammatory reaction of fat and muscle by reducing weight.Additionally,SGLT2i increases fracture risk more likely to be associated with falls and volume depletion secondary to osmotic diuresis in older patients with insufficient renal function and high cardiovascular risk.
作者
柴家超
杨卫芳
扈艳雯
张玉超
赵蕙琛
CHAI Jiachao;YANG Weifang;HU Yanwen;ZHANG Yuchao;ZHAO Huichen(Department of Pediatric Orthopedics,Qingdao Women and Children’s Hospital,Qingdao 266034,China;Department of Endocrinology,Qingdao Municipal Hospital,Qingdao 266071,China;Department of Nutritional,Heze Municipal Hospital,Heze 274031,China)
出处
《中国骨质疏松杂志》
CAS
CSCD
北大核心
2023年第12期1866-1872,共7页
Chinese Journal of Osteoporosis
基金
山东省自然科学基金面上项目(ZR202111120136)
山东省医药卫生科技发展计划项目(202203060248)。
