To explore the relationship of visceral fat with BMD and osteoporotic fracture risk in T2DM patients.

Participants were selected during July to December 2019, including 202 T2DM inpatients from Endocrine Department, Yiyang Central Hospital, and 202 non-diabetics from three towns (Mahekou, Nanzhou, and Maocaojie) and one township (Wuzui) of Nan County, Yiyang, using multistage stratified random sampling. All the assessment examinations were conducted in Yiyang Central Hospital, specifically, BMD at lumbar spine, femoral neck and total hip was measured by dual-energy X-ray absorptiometry, subcutaneous and visceral fat areas were measured by DUALSCAN HDS-2000 visceral fat analyzer (Omron, Japan), and 10-year major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture) or 10-year hip osteoporotic fracture risk was assessed by FRAX questionnaire. T2DM inpatients who completed a FRAX questionnaire in which the item of rheumatoid arthritis was substituted by diabetes, namely, diabetes was considered as a risk factor for osteoporotic fractures, whose assessment results were expressed by FRAX2, otherwise, their assessment results were expressed by FRAX1.

Type 2 diabetic men had higher average weight and BMI, and greater average areas of visceral and subcutaneous fat, and lower average FRAX1 (major osteoporotic fracture) than non-diabetic men (P<0.05). Type 2 diabetic women had greater average age and visceral fat area, lower femoral neck and total hip BMD, and higher average FRAX1 (hip osteoporotic fracture) and FRAX2 (major osteoporotic fracture) and FRAX2 (hip osteoporotic fracture) than non-diabetic women (P<0.05). After adjusting for age and weight, total hip BMD in type 2 diabetic women were lower than those in non-diabetic women (P<0.05). Pearson correlation analysis results showed that visceral fat area was positively correlated with weight, BMI, subcutaneous fat area, BMD at lumbar spine, femoral neck and total hip in non-diabetic men and postmenopausal women (P<0.05). Visceral fat area was positively correlated with weight, BMI, subcutaneous fat area and total hip BMD in non-diabetic women (P<0.05). Visceral fat area was positively correlated with weight, BMI, subcutaneous fat area, lumbar spine BMD and total hip BMD in T2DM men (P<0.05). Visceral fat area was positively correlated with weight, BMI, subcutaneous fat area and total hip BMD in women or postmenopausal women with T2DM (P<0.05). Partial correlation analysis results showed that after adjusting for age and weight, visceral fat area was negatively correlated with femoral neck BMD, and total hip BMD in T2DM women (P<0.05). Visceral fat area was negatively correlated with femoral neck BMD, but positively correlated with FRAX1 (hip osteoporotic fracture) or FRAX2 (hip osteoporotic fracture) in T2DM postmenopausal women (P<0.05) .

T2DM patients had higher weight, BMI and visceral fat area than those without diabetes. T2DM women had lower femoral neck BMD and hip BMD, and may be at higher risk of 10-year hip osteoporotic fracture. Visceral fat area was negatively correlated with femoral neck BMD and total hip BMD in T2DM women. The risk of 10-year hip osteoporotic fracture may increase as visceral fat area increases in postmenopausal women with or without T2DM.

探究2型糖尿病患者内脏脂肪与骨密度及骨折风险的相关性。

选取2019年7—12月在益阳市中心医院内分泌科住院的2型糖尿病患者202例。同期采用多阶段分层整群随机抽样的方法，抽取益阳市南县麻河口镇、南洲镇、乌嘴乡、茅草街镇非糖尿病者202例为对照，均于益阳市中心医院进行检查。使用双能X线检测腰椎、股骨颈、总髋骨密度；使用欧姆龙内脏脂肪检测仪测量皮下、内脏脂肪面积。采用骨折风险评估工具（FRAX问卷）评估未来10年主要部位及髋部骨质疏松性骨折风险。若为糖尿病人群，不纳入糖尿病作为骨质疏松风险因素所得结果用FRAX1表示；纳入糖尿病作为骨质疏松性骨折风险因素则将所得结果用FRAX2表示。

2型糖尿病男性体质量、体质指数（BMI）高于非糖尿病男性，内脏脂肪面积、皮下脂肪面积大于非糖尿病男性，FRAX1（主要部位）低于非糖尿病男性（P<0.05）。2型糖尿病女性年龄、内脏脂肪面积大于非糖尿病女性，股骨颈骨密度、总髋骨密度低于非糖尿病女性，FRAX1（髋部）、FRAX2（主要部位）、FRAX2（髋部）高于非糖尿病女性（P<0.05）。校正年龄、体质量后，2型糖尿病女性总髋骨密度低于非糖尿病女性（P<0.05）。Pearson相关分析结果显示：在非糖尿病人群中，男性及绝经后女性内脏脂肪面积与体质量、BMI、皮下脂肪面积、腰椎骨密度、股骨颈骨密度、总髋骨密度均呈正相关（P<0.05），女性内脏脂肪面积与体质量、BMI、皮下脂肪面积、总髋骨密度呈正相关（P<0.05）。在2型糖尿病患者中，男性内脏脂肪面积与体质量、BMI、皮下脂肪面积、腰椎骨密度、总髋骨密度均呈正相关（P<0.05），女性、绝经后女性内脏脂肪面积与体质量、BMI、皮下脂肪面积、总髋骨密度呈正相关（P<0.05）。偏相关分析结果显示：校正年龄、体质量后，在2型糖尿病患者中，女性内脏脂肪面积与股骨颈骨密度、总髋骨密度呈负相关（P<0.05），绝经后女性内脏脂肪面积与股骨颈骨密度呈负相关，与FRAX1（髋部）、FRAX2（髋部）呈正相关（P<0.05）。

2型糖尿病患者较非糖尿病人群有较高的体质量、BMI及内脏脂肪面积。2型糖尿病女性患者股骨颈骨密度及髋部骨密度较低，其未来10年髋部骨质疏松性骨折风险较高。2型糖尿病女性患者内脏脂肪面积与股骨颈骨密度及总髋骨密度呈负相关，且随着内脏脂肪面积增加绝经后女性未来10年髋部骨质疏松性骨折风险增加。