ABSTRACT
BACKGROUND:Diabetes mel itus can give rise to bone metabolic disorders in patients, resulting in the occurrence of osteoporosis and low traumatic fractures. However, the pathogenesis mechanism remains unclear. OBJECTIVE:To review the current research progress in the bone metabolic disorders resulting from diabetes mel itus, and to provide theoretical basis of the prevention and treatment of diabetic osteopathy. METHODS:A computer-based online search was conducted in Pubmed database (http://www.ncbi.nlm.nih.gov/pubmed/) from January 2000 to December 2013. Articles focusing on diabetes mel itus regulating bone metabolism were col ected using the key words of“diabetes mel itus;bone”in English. High-quality relevant studies were included, while repetitions and unidirectional studies were excluded. RESULTS AND CONCLUSION:A total of 6 979 articles were obtained initial y, and after screening procedures 58 literatures were selectively included in this review. Although type 1 and type 2 diabetes mel itus exert different effects on the bone mineral density, they ultimately result in osteoporosis and low traumatic fractures. It is widely believed that the pathogenesis may be that high glucose breaks the balance between bone formation and bone absorption, so that bone absorption is greater than bone formation. The number of the osteoclasts is increased, while the cytokines of promoting osteogenesis are restrained. As a consequence, those result in low bone mineral density, brittle bone and high incidence of fracture.
ABSTRACT
Objective To investigate the awareness rate,treatment rate and control rate of mineral and bone disorder in patients with moderate or advanced stage chronic kidney disease (CKD). Methods The awareness rate,treatment rate and control rate of mineral and bone disorder were evaluated based on a questionnaire and related laboratory examinations in 503 CKD stage 3 to 5 patients. Results The awareness rate of mineral and bone disorder in patients with moderate or advanced stage CKD was highest in hemodialysis patients,moderate in peritoneal dialysis patients and lowest in non-dialyzed patients (all P ＜0.01).The total scores of the questionnaire were lowest in non-dialyzed patients [6 (5,8)] and were significantly higher in peritoneal dialysis [11 (9,12)] and hemodialysis patients [13 (11,15)] (P＜0.01).The extent of awareness was negatively correlated with age (r=-0.11,P＜0.05),and positively correlated with educational background (r=0.226,P＜0.01),duration of CKD (r=0.597,P＜0.01) and duration of dialysis (r=0.366,P＜0.01).The source of knowledge was mainly from publicity and education made by medical staff,which accounted for 94.0％,79.5％ and 69.4％ respectively in nondialyzed,peritoneal dialysis and hemodialysis patients.The treatment rate was significantly higher in peritoneal dialysis (88.6％) and hemodialysis patients (96.9％) than that in non-dialyzed patients (58.2％) (all P＜0.01).According to K/DOQI guideline,the control rate of serum calcium,phosphorus,calcium and phosphorus product and parathyroid hormone (PTH) were much better in non-dialyzed patients as compared to dialyzed ones.The percentage of number of lab indicators meeting the standard was significantly higher in non-dialyzed patients as compared to dialyzed ones (P＜0.01).According to KDIGO guideline,the control rate of serum phosphorus was significantly lower in hemodialysis patients (23.6％) than that in peritoneal dialysis (36.9％) and non-dialyzed patients (46.7％) (P＜0.01). Conclusions In non-dialyzed patients with moderate or advanced stage CKD,the awareness rate and treatment rate of mineral and bone disorder are relatively low,and the control rate is relatively high.Whereas in dialyzed patients,the awareness rate and treatment rate are relatively high,and the control rate is relatively low.