老年2型糖尿病患者甲状腺激素敏感性指标与骨质疏松的相关性OA

Objective To investigate the correlation between thyroid hormone sensitivity indices and osteoporosis(OP)in elderly patients with type 2 diabetes mellitus(T2DM).Methods A total of 216 elderly T2DM patients admitted to Xingtai Hospital of Traditional Chinese Medicine from January 2021 to December 2024 were selected.According to bone mineral density(BMD)values,patients were assigned to an OP group(n=49)and a non-OP group(n=167).Thyroid hormone sensitivity indices(free triiodothyronine/free thyroxine ratio[FT3/FT4],thyroid feedback quantile index[TFQI],thyroid-stimulating hormone index[TSHI],thyrotrophin thyroxine resistance index[TT4RI]),BMD,and general data including age,sex,and duration of T2DM were compared between the two groups.The relationship between thyroid hormone sensi-tivity indices and OP and their predictive value for OP were analyzed.Results There were no statistically significant differ-ences in TSHI and FT3/FT4 levels between the two groups(P>0.05).The TFQI level in the OP group was higher than that in the non-OP group,and the TT4RI level was lower than that in the non-OP group,with statistically significant differ-ences(P<0.05).There were no statistically significant differences between the two groups in age,duration of T2DM,di-astolic blood pressure(DBP),systolic blood pressure(SBP),fasting plasma glucose(FPG),2-hour postprandial plasma glucose(2 h PG),alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine(Cr),uric acid(UA),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein choles-terol(LDL-C),serum calcium(Ca),serum phosphorus(P),FT3,and FT4;P>0.05.The proportion of female partici-pants and the level of glycosylated hemoglobin(HbA1c)in the OP group were higher than those in the non-OP group,while the level of thyroid-stimulating hormone(TSH)was lower than that in the non-OP group,with statistically significant differences(P<0.05).Multivariate logistic regression analysis showed that elevated TFQI level(OR=2.164,95%CI:1.056-4.433),decreased TT4RI level(OR=0.616,95%CI:0.514-0.737),female sex(OR=4.105,95%CI:1.177-14.316),and elevated HbA1c level(OR=3.624,95%CI:1.877-6.998)were risk factors for OP in elderly T2DM pa-tients(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that among the single indicators(TFQI,TT4RI,sex,HbA1c)for predicting OP in elderly T2DM patients,TT4RI had the highest area under the curve(AUC=0.933),with a sensitivity of 89.80%and specificity of 83.23%.The combined prediction of OP using the four indicators yielded an AUC of 0.972,which was higher than that of each single indicator(TFQI,TT4RI,sex,HbA1c;Z=8.198,2.762,8.172,4.936,respectively,P<0.05),with a sensitivity of 87.76%and specificity of 94.61%.Conclusion De-creased TT4RI,elevated TFQI,female sex,and elevated HbA1c level are risk factors for OP in elderly T2DM patients.These indicators can effectively predict the risk of OP in elderly T2DM patients,and their combined application can further increase predictive performance,warranting clinical attention.