PDF(Pubmed)
Abstract：
Growing evidence suggests that diabetes mellitus is associated with an increased risk of fracture. Bone intrinsic factors (such as accumulation of glycation end products, low bone turnover, and bone microstructural changes) and extrinsic factors (such as hypoglycemia caused by treatment, diabetes peripheral neuropathy, muscle weakness, visual impairment, and some hypoglycemic agents affecting bone metabolism) probably contribute to damage of bone strength and the increased risk of fragility fracture. Traditionally, bone mineral density (BMD) measured by dual x-ray absorptiometry (DXA) is considered to be the gold standard for assessing osteoporosis. However, it cannot fully capture the changes in bone strength and often underestimates the risk of fracture in diabetes. The fracture risk assessment tool is easy to operate, giving it a certain edge in assessing fracture risk in diabetes. However, some parameters need to be regulated or replaced to improve the sensitivity of the tool. Trabecular bone score, a noninvasive tool, indirectly evaluates bone microstructure by analyzing the texture sparsity of trabecular bone, which is based on the pixel gray level of DXA. Trabecular bone score combined with BMD can effectively improve the prediction ability of fracture risk. Quantitative computed tomography is another noninvasive examination of bone microstructure. High-resolution peripheral quantitative computed tomography can measure volume bone mineral density. Quantitative computed tomography combined with microstructure finite element analysis can evaluate the mechanical properties of bones. Considering the invasive nature, the use of microindentation and histomorphometry is limited in clinical settings. Some studies found that the changes in bone turnover markers in diabetes might be associated with fracture risk, but further studies are needed to confirm this. This review focused on summarizing the current development of these assessment tools in diabetes so as to provide references for clinical practice. Moreover, these tools can reduce the occurrence of fragility fractures in diabetes through early detection and intervention.
摘要：
越来越多的证据表明，糖尿病与骨折风险增加有关。骨内在因素(如糖基化终产物的积累，低骨转换，和骨微结构变化）和外在因素（如治疗引起的低血糖，糖尿病周围神经病变，肌肉无力,视力障碍，和一些影响骨代谢的降血糖药）可能导致骨强度的损害和脆性骨折的风险增加。传统上,通过双X线吸收法(DXA)测量的骨矿物质密度(BMD)被认为是评估骨质疏松症的金标准.然而,它不能完全捕捉到骨强度的变化，并且常常低估了糖尿病患者骨折的风险。断裂风险评估工具操作简便,在评估糖尿病患者的骨折风险方面具有一定的优势。然而,一些参数需要调整或更换，以提高工具的灵敏度。骨小梁评分,一种非侵入性工具，通过分析骨小梁的纹理稀疏度来间接评价骨的微观结构，这是基于DXA的像素灰度级。骨小梁评分联合BMD可有效提高骨折风险预测能力。定量计算机断层扫描是骨微结构的另一种非侵入性检查。高分辨率外周定量计算机断层扫描可以测量骨矿物质密度。定量计算机断层扫描结合微观结构有限元分析可以评估骨骼的机械性能。考虑到侵入性，微压痕和组织形态计量学的应用在临床上受到限制.一些研究发现，糖尿病患者骨转换标志物的变化可能与骨折风险有关，但需要进一步的研究来证实这一点。本文就糖尿病评估工具的发展现状进行综述,以期为临床提供参考。此外，这些工具可以通过早期发现和干预减少糖尿病患者脆性骨折的发生。
