目的 应用FRAX模型评估老年2型糖尿病和非糖尿病患者的骨折风险,明确FRAX模型评估中国大陆老年2型糖尿病亚群的骨折风险的有效性。方法 随机选取2型糖尿病老年患者267例,对照组（非糖尿病患者）359例,进行调查问卷、骨密度测量、FRAX 分值计算。应用二分类变量回归方法分析FRAX高骨折风险的相关因素。结果 2型糖尿病组体质指数、腰臀比、吸烟比例、饮酒比例均高于对照组（P<0.001）。2型糖尿病组股骨颈和腰椎骨矿含量、骨密度T值、Z值均高于对照组。2型糖尿病组应用FRAX–BMI模型预估10年主要骨质疏松性骨折（MOF）和髋部骨折（HF）风险均低于对照组[（4.27±2.84）% 对 （5.14±2.92）%, P<0.001; （1.42±1.54）% 对 （1.83±2.23）%, P <0.001）]。应用FRAX-BMD模型评估2型糖尿病组MOF风险低于对照组[（5.28±4.41）% 对 （6.30±5.10）%, P <0.001）]。回归分析显示股骨颈骨密度T值,吸烟,髋部骨折家族史和糖皮质激素应用与髋部骨折高风险有关。股骨颈骨密度T值,吸烟,髋部骨折家族史和既往脆性骨折史与MOF高风险有关。是否罹患2型糖尿病不是FRAX模型预估高骨折风险的相关因素。结论 中国2型糖尿病老年患者应用FRAX模型预估10年骨折风险低于非糖尿病人群预估结果,提示FRAX模型并不完全适合中国人群。
Objective To assess the fracture risk of elderly patients with and without type 2 diabetes mellitus （T2DM） by FRAX model, and to ascertain the validity of this model in assessing the fracture risk of elderly patients with T2DM in the mainland of China. Methods A total of 267 T2DM and 359 non-diabetic （control） patients were randomly selected, completed a questionnaire survey, underwent bone mineral density measurement, and were assessed by FRAX model. Binary regression analysis was used to evaluate the risk factors for high-risk fracture predicted by FRAX model. Results The body mass index （BMI）, waist-hip ratio, and the proportions of smoking and drinking were all higher in the T2DM group than those in the control group （P<0.001）. The bone mineral content, T value, and Z value of femoral neck （FN） and lumbar vertebra （L） in the T2DM group were also high. The T2DM group showed lower risks of 10-year major osteoporotic fracture （MOF） and hip fracture （HF） by FRAX-BMI model than the control group ［（4.27±2.84）% vs. （5.14±2.92）%, P<0.001, and （1.42±1.54）% vs. （1.83±2.23）%, P<0.001］. The T2DM group also showed a lower risk of MOF by FRAX-BMD model than the control group ［（5.28±4.41）% vs. （6.30±5.10）%, P<0.001］. Regression analysis results showed that the T score of FN, smoking, family history of hip fracture, and glucocorticoid use were associated with high-risk HF. The T score of FN, smoking, family history of HF, and history of brittle fracture were associated with high-risk MOF. T2DM was not associated with high-risk fracture predicted by the FRAX model. Conclusion The FRAX model predicts a lower 10-year fracture risk in elderly Chinese patients with T2DM than in non-diabetic patients, indicating that the model is not well suited for the Chinese population.
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