Association of skin autofluorescence with low bone density/osteoporosis and osteoporotic fractures in type 2 diabetes mellitus

J Diabetes. 2022 Sep;14(9):571-585. doi: 10.1111/1753-0407.13309. Epub 2022 Sep 4.

Abstract
in English, Chinese

Background: Advanced glycation end products (AGEs) that abnormally accumulate in diabetic patients have been reported to damage bone health. We aimed to investigate the association between skin autofluorescence (SAF)-AGEage (SAF - AGEs × age/100) and low bone density (LBD)/osteoporosis or major osteoporotic fractures (MOFs) in patients with type 2 diabetes mellitus (T2DM).

Methods: This study was nested in the prospective REACTION (Risk Evaluation of Cancers in Chinese Diabetic Individuals) study and included 1214 eligible participants. SAF was used to measure skin AGEs (SAF-AGEs). Fracture events were determined by an in-person clinical follow-up. Binary logistic regression analysis, linear regression analysis, and a restricted cubic spline nested in logistic models were used to test outcomes.

Results: The overall prevalence of LBD/osteoporosis in middle-aged or elderly T2DM patients was 35.7% (n = 434), and the overall incidence of MOFs was 10.5% (n = 116). Logistic analysis showed a significantly positive relationship between quartiles of SAF-AGEage and the risk of LBD/osteoporosis (odds ratio [OR] 2.02, 95% CI 1.34-3.03; OR 3.63, CI 2.44-5.39; and OR 6.51, CI 4.34-9.78) for the multivariate-adjusted models, respectively. SAF-AGEage was associated with MOFs with a multivariate-adjusted OR of 1.02 (CI 0.52-2.02), 2.42 (CI 1.32-4.46), and 2.70 (CI 1.48-4.91), respectively. Stratified analyses showed that SAF-AGEage was significantly associated with MOFs only in females, nonsmokers, nondrinkers, individuals with lower body mass index, and those without LBD/osteoporosis. Linear regression analyses showed that higher SAF-AGEs were associated with a higher level of serum N-terminal propeptide of type I procollagen (s-PINP) and serum carboxy-terminal cross-linking peptide of type I collagen (s-CTX), with a multivariate-adjusted OR of 1.02 (CI 0.24-1.80) and 6.30 (CI 1.77-10.83), respectively.

Conclusions: In conclusion, SAF-AGEage was positively associated with the prevalence of LBD/osteoporosis or MOFs in patients with T2DM. A positive association between SAF-AGEs and the level of s-PINP and s-CTX was found.

背景: 糖基化终末产物(AGEs)在糖尿病患者体内异常积聚，已有报道会损害骨健康。本研究旨在探讨皮肤自发荧光(SAF)-AGEage (SAF-AGEs×age/100)与2型糖尿病(T2DM)患者低骨密度(LBD)/骨质疏松或主要骨质疏松性骨折(MOF)的关系。 方法: 本研究整合在前瞻性 (中国糖尿病患者癌症风险评估) REACTION研究中，包括1214名符合条件的参与者。用SAF测量皮肤年龄(SAF-AGE)。骨折事件通过临床随访来确定。使用二元Logistic回归分析, 线性回归分析和在Logistic模型中的限制立方样条法来检验结果。 结果: 中老年T2DM患者LBD/骨质疏松总患病率为35.7%(n=434)，MOFs总患病率为10.5%(n=116)。Logistic回归分析显示，SAF-AGEage 的四分位数与LBD/骨质疏松的风险呈显著正相关[OR 2.02，95%置信区间(CI)1.34~3.03；OR 3.63，CI 2.44~5.39；OR 6.51；CI 4.34~9.78]。SAF-AGEage 与MOF相关，多因素校正OR值分别为1.02；CI 0.52~2.02，OR 2.42；CI 1.32~4.46，OR 2.70；CI 1.48~4.91。分层分析显示，SAF-AGEage 仅在女性, 非吸烟者, 不饮酒者, 体重指数较低的个人以及没有LBD/骨质疏松的人中与MOF显著相关。线性回归分析显示，SAF-AGEs越高，血清s-PINP和s-CTX水平越高，多因素校正后的OR值分别为1.02, CI 0.24~1.80和6.30, CI 1.77~10.83。 结论: 在T2DM患者中，SAF-AGEage 与LBD/骨质疏松或MOFs的患病率呈正相关。SAF-AGEs与血清s-PINP, s-CTX水平呈正相关。.

Keywords: 2型糖尿病(T2DM); advanced glycation end products (AGEs); bone turnover; osteoporosis; osteoporotic fractures; type 2 diabetes mellitus (T2DM); 糖基化终产物(AGEs); 骨质疏松; 骨质疏松骨折; 骨转换.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers
  • Collagen Type I
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / epidemiology
  • Female
  • Glycation End Products, Advanced
  • Humans
  • Middle Aged
  • Osteoporosis* / epidemiology
  • Osteoporotic Fractures* / epidemiology
  • Osteoporotic Fractures* / etiology
  • Peptides
  • Prospective Studies
  • Skin

Substances

  • Biomarkers
  • Collagen Type I
  • Glycation End Products, Advanced
  • Peptides