甲状腺功能正常的2型糖尿病患者甲状腺激素敏感性指标与骨质疏松症的关系研究

Background  With the increasing aging populationthe prevalence of osteoporosis in patients with type 2diabetes mellitusT2DMis rising year by year. It has also been found that impaired sensitivity to thyroid hormone is associated with abnormal bone metabolism. Howeverthere are few studies on the relationship between thyroid hormone sensitivity and the risk of osteoporosis in patients with T2DM. Objective  To analyze the relationship between thyroid hormone sensitivity index and osteoporosis in T2DM patients with normal thyroid function. Methods  This cross-sectional study included 723 T2DM patients with normal thyroid function admitted to the Department of Endocrinology of Nanjing University Affiliated Drum Tower Hospital from 2022 to 2023. Based on the results of bone mineral densityBMDmeasurementsthe patients were divided into three groupsnormal bone mass groupn=362osteopenia groupn=291and osteoporosis groupn=70. The thyroid feedback quotient indexTFQIthyroid-stimulating hormone indexTSHIthyroid-stimulating hormone resistance indexTT4RIand the ratio of free triiodothyronine to free thyroxineFT3/FT4were measured and calculated in each patient to assess thyroid hormone sensitivity. One-way analysis of varianceANOVAand chi-square test were used for intergroup comparisons. Spearman's correlation analysis and logistic regression analysis were employed to explore the association between thyroid hormone sensitivity indices and the risk of osteoporosis in T2DM patients. Results  The osteoporosis group had higher ageproportion of femalesdiabetes durationsystolic blood pressurebody mass indexBMI2-hour postprandial glucose2 hPGalanine aminotransferaseALThigh-density lipoprotein cholesterolHDL-Cand TFQI compared with the normal bone mass groupP<0.05. In contrastdiastolic blood pressurecreatininetriglyceridesFT3and FT3/FT4 were lower in the osteoporosis group than in the normal bone mass groupP<0.05. The osteoporosis group also had higher ageproportion of femalesdiabetes duration2 hPGHDL-Cand TFQI compared with the osteopenia groupP<0.05while ALTtriglyceridesFT3and FT3/FT4 were lowerP<0.05. Spearman rank correlation analysis showed that the occurrence of osteoporosis in T2DM patients was positively correlated with TFQIrs=0.553P<0.001and negatively correlated with FT3 and FT3/FT4rs=-0.098P=0.009rs=-0.080P=0.031. Multivariate logistic regression analysis revealed thatafter adjusting for confounding factorsTFQI was positively associated with the risk of osteoporosis in T2DM patientsOR=6.61295%CI=5.793-8.192. The area under the receiver operating characteristicROCcurveAUCfor predicting the risk of osteoporosis in T2DM patients using TFQI was 0.83195%CI=0.794-0.867with a best cutoff value of -0.029. The sensitivity and specificity were 100.0% and 55.4%respectively. Conclusion  Elevated levels of TFQI are associated with a higher risk of osteoporosis in T2DM patients with normal thyroid functionsuggesting that reduced central sensitivity to thyroid hormone in this population is related to the development of osteoporosis.