ABSTRACT
Objective To research the changes of calcium regulation hormone and bone mineral density (BMD) in type 2 diabetes mellitus (T2DM ) patients and analyze the main impact factors. Methods 117 T2DM patients (T2DM group ,M/F=52/65 ,age 40~79 years) and 63 age‐ and gender‐matched healthy people (NC group) were selected in this study. According to the course of diabetes ,blood glucose control and the value of BMD ,T2DM patients were divided into subgroups :course≤10 years ,and>10 years ;HbA1 c≤8% ,and>8% ;normal BMD ,osteopenia ,and osteoporosis (OP). Serum 25‐hydroxy vitamin D3 [25(OH)D3 ]and Parathormone (PTH) were measured and BMDs of lumbar spine (L1 ~L4 ) , femoral neck ,total hip ,and whole body were evaluated for all the subjects. Result (1)Compared with NC group ,the level of serum 25(OH)D3 and BMDs of femoral neck and total hip decreased significantly in T2DM group[ (35.57 ± 12.30)nmol/L ,(0.848 ± 0.136)g/cm2 ,(0.873 ± 0.150)g/cm2 vs(44.94 ± 17.40) nmol/L ,(0.927 ± 0.173)g/cm2 ,(0.934 ± 0.140)g/cm2 ,respectively ,P10 years[ (0.814 ± 0.148) ,(0.840 ± 0.157) vs (0.882 ± 0.111) ,(0.908 ± 0.139) g/cm2 ,respectively ,P0.05). (3)Compared with HbA1c≤8% group ,BMD of femoral neck and total hip in HbA1c> 8% group decreased [(0.830 ± 0.131) ,(0.832 ± 0.161) vs (0.891 ± 0.130) ,(0.949 ± 0.130)g/cm2 ,respectively ,P 0.05). (4)The rates of OP and osteopenia (41.03% ,47.86% ) in T2DM were higher than those in NC group (26.98% ,33.33% ) (χ2 =4.367 ,4.669 ,P<0.05). The duration of diabetes and the levels of HbA1c and PTH were longer or higher in OP group than those with normal BMD or osteopenia (P<0.05). (5)Logistic regression analysis showed that BMD negatively correlated with the duration of diabetes ,HbA1c ,and PTH (β= 0.076 ,0.213 ,0.112 ,respectively ,P< 0.05) ,and positively correlated with 25(OH)D3 (β= -0.043 ,P<0.05). Conclusion The values of BMD decreased and the incidence of OP is higher in T2DM patients ,particularly in patients with longer diabetic duration and poor glycemic control.
ABSTRACT
La osteomalacia inducida por tumor es un síndrome paraneoplásico secundario en la mayoría de los casos a tumores de origen mesenquimal. Se caracteriza por pérdida aumentada de fosfato a nivel urinario por el efecto inhibidor que ejerce el factor de crecimiento fibroblástico 23 sobre el transporte de fósforo en el túbulo renal proximal. Debe sospecharse en un paciente con debilidad y dolor osteomuscular generalizado que se presente con hipofosfatemia, normocalcemia, fosfatasa alcalina elevada y niveles de 25 hidroxivitamina D y PTH normales. El tratamiento definitivo de la enfermedad es la resección quirúrgica del tumor. Cuando se desconozca la neoplasia primaria o no sea posible el tratamiento quirúrgico debe iniciarse reposición de fósforo y calcitriol. En este artículo se presenta el primer caso de una paciente con osteomalacia inducida por tumor asociada a un carcinoma lobulillar infiltrante de seno.
The tumor-induced osteomalacia is a paraneoplastic syndrome secondary in most cases to tumors of mesenchymal origin. It is characterized by increased lost of urinary phosphate by the inhibitory effect exerted by the fibroblast growth factor 23 on phosphorus transport in the proximal renal tubule. Should be suspected in a patient with weakness and generalized muscle in addition to hypophosphatemia, normocalcemia, elevated alkaline phosphatase and normal serum 25-hydroxyvitamin D and PTH. The definitive treatment of the disease is surgical resection of the tumor. When the primary tumor is unknown or is not possible the surgical treatment should be initiated replacement of phosphorus and calcitriol. This paper presents the first case of a patient with tumor-induced osteomalacia associated with lobular breast cancer.