Case study of 43 cases of diabetes

Diabetes in our country a popular trend, the heart, brain, kidney, eye and skin, neurological, reproductive and other complications have been widely recognized, and diabetes mellitus complicated with osteoporosis in recent years before they were aware of the medical profession.易致because of osteoporosis fractures, disabling high, so that patients with diabetes treatment and rehabilitation more difficult, serious impact on quality of life of patients, and to increase the financial burden on patients, not only are medical problems, but also a serious social problem start has been of great importance to scholars both at home and abroad. Therefore, 43 cases of our patients with type 2 diabetes to bone mineral density and bone metabolic markers in the determination to explore type 2 diabetes and osteoporosis-related factors and mechanisms, with a view to an early stage of diabetes to prevent and treat osteoporosis. Are reported as follows.
One object and methods

1.1 Object WHO1999 years in accordance with the recommended diagnostic criteria for diabetes, randomly selected in May 2005 ~ June 2006 hospitalized patients with type 2 diabetes 43 cases, none of the combined liver, kidney, thyroid, parathyroid disease, not the use of the impact of bone metabolism drug. Man one of 23 cases, 20 cases of female, age 34 ~ 60 years old, average 58 years old, the course for 3 months to 15 years, an average of 5.8 years. Selection to match age and disease group, 43 cases of the same sex for the physical health of workers in normal control group, no bone metabolic diseases, liver and kidney function was normal. Man one of 21 cases, 22 cases of female, age 36 ~ 58 years old, average 56-year-old.
1.2 Ways

1.2.1 Bone mineral density (BMD) was measured by BMD-4-based bone density scanner, single-photon absorption method ulnar, radial bone mineral density.

1.2.2 Indicators of bone metabolism was determined by the United States company Metra kit to enzyme-linked immunosorbent assay were measured by fasting serum osteocalcin (BGP) and morning urine deoxypyridinoline (Dpd) values.
1.3 statistical methods were t tests and the number of treatment.
2 results

2.1 in type 2 diabetic patients with normal bone metabolism in the control group results from Table 1 that bone mineral density in diabetic group, serum osteocalcin, urinary deoxypyridinoline measured values were lower than the control group, there was a significant difference (P <0.01) .

Table 1 Comparison of two groups of bone metabolism (abbreviated)
2.2 Determination of the value of bone mineral density in diabetic group matched by age, gender, mean bone mineral density in normal people the same minus two standard deviation as a lower bone mineral density, that is, to reduce the diagnostic criteria for osteoporosis. 43 cases of type 2 diabetes has prompted the value of bone mineral density decreased bone mineral density of 25 people, accounting for 58.14% (25/43).

3 discussions

Diabetes caused by reducing the incidence of bone mineral density, both at home and abroad is reported as 9.8% ~ 66% [1]. Table 1, 43 patients with type 2 diabetes, which has 58.14% (25/43 cases) have varying degrees of reduced bone mineral density, bone mineral content reduction. Most patients have lumbar acid, back pain, lower limb pain and fatigue, consistent with reported in the literature.



Osteocalcin is synthesized by osteoblasts secreted by a non-collagenous protein, is a reflection of osteoblast activity sensitive indicators. And urinary deoxypyridinoline is the only type Ⅰ collagen in bone, the bone collagen molecules, when dissolved protein hydrolysis, as osteoclast degradation by-products released into the blood to urine discharged from the prototype, is a bone resorption specific, sensitive indicators [2]. Diabetic group showed that BGP, Dpd was significantly increased on bone resorption in patients with type 2 diabetes is greater than bone formation, leading to bone loss and osteoporosis. Simultaneous determination of someone with diabetes DPD excretion rate and bone mineral density was found in the formation of osteoporosis before the urine DPD have been significantly increased [3].

In this paper, results show that bone abnormalities are common in patients with type 2 diabetes complications, mainly to reduce osteoporosis, osteoporosis can occur. Patients with type 2 diabetes secondary osteoporosis mechanism consider the following factors mainly related to: ① diabetes long-term glucose metabolism disorder, their high blood sugar makes substantial calcium permeability diuresis with urine discharge, resulting in a negative calcium balance caused by thyroid secondary side gland hyperfunction. Parathyroid hormone levels, and promote increased bone resorption, eventually leading to osteoporosis [4]. Therefore, the degree of control of glucose metabolism and bone mineral density has a certain relevance [5]. ② shortage of patients with diabetes or insulin sensitivity decreased, increased body protein catabolism, synthesis reduction, bone tissue and collagen protein to reduce the total composition, so that calcium, phosphorus and other mineral elements difficult deposition, caused by osteoporosis. At the same time, the lack of insulin and suppress the body's synthesis of vitamin D, vitamin D reduce the impact on calcium absorption and utilization. Osteoblast surface insulin receptor, insulin not only can directly promote bone cells on amino acid uptake and stimulate bone collagen synthesis and nucleotide formation, but also to PTH, 1,25 - (OH) 2 D 3, insulin-like growth factor (IGF) on osteoblast function, so that increased activity of osteoblasts, their differentiation and maturation. At the lack of insulin or IGF, based on sustained high blood sugar can inhibit the proliferation of osteoblasts, so that the number of osteoblast activity were reduced, thereby causing osteoporosis. Therefore, diabetes consider reducing osteoporosis and the lack of insulin and vitamin D is closely related to metabolic abnormalities. ③ diabetes control diet when sick, pay no attention to the added calcium, resulting in low levels of calcium, can cause secondary hyperparathyroidism. Increased parathyroid hormone secretion may be the mobilization of calcium into the blood circulation and increase osteoporosis.

Diabetic osteoporosis early morning anti-governance is very important measures are as follows: ① first urine of patients with blood glucose control to a more satisfactory indicator of the degree. Blood glucose levels close to or returned to normal, diabetic patients will enable the calcium, phosphorus, magnesium, zinc and nitrogen metabolism to balance the imbalance. ② to maintain a balanced diet, reduce the incidence of osteoporosis are the most important one of the ways. Calcium and vitamin D for normal bone metabolism is the most important. ③ to maintain a healthy lifestyle. Smoking and alcohol can affect bone mass, therefore need to get rid of. And exercise can increase bone mass, therefore, has to promote. ④ regular monitoring of bone mineral density and, if necessary, add drug intervention osteoporosis, such as the application of calcitonin agents inhibit osteoclastic activity and reduce bone pain have better efficacy; or oral bisphosphonate drugs inhibit bone resorption and prevent bone further loss of quality. Can be supplemented with both calcium and vitamin D preparations. Fluoride can also be applied drugs to stimulate osteoblast activity to promote bone formation.