臺灣中老年非糖尿病族群胰島素阻抗與骨質疏鬆之相關性

Abstract

背景 骨質疏鬆症是公共衛生上的重要議題，而第二型糖尿病是其風險因子之一。已知第二型糖尿病患者有較高的胰島素阻抗，並伴隨較高的骨質疏鬆症風險。然而，非糖尿病者的胰島素阻抗與骨質密度、骨質疏鬆症風險的關係，過去研究並未有一致的結論。本研究旨在探索非糖尿病者的胰島素阻抗與骨質疏鬆症及骨質密度的相關性。

方法 本文採橫斷式研究設計，納入台北一家健檢中心在2023年的所有受檢者。研究對象為無糖尿病的50歲以上男性及停經後婦女，分別採用六項胰島素阻抗（或敏感度）指標：Homeostatic model assessments of insulin resistance and β-cell function（HOMA-IR、HOMA-β、HOMA2-IR、HOMA2-β）、Quantitative insulin sensitivity check index（QUICKI）、McAuley，以羅吉斯迴歸模型及線性迴歸模型取得多變項調整後之骨質疏鬆症的勝算比及胰島素阻抗（或敏感度）與三部位（左側股骨頸、左側髖骨、腰椎）骨質密度的相關性。

結果 共有2,202人進入研究分析。胰島素阻抗指標中，HOMA-IR、HOMA2-IR與骨質疏鬆的發生有顯著正相關（HOMA2-IR調整後勝算比為1.16，95%信賴區間為1.01-1.32），而胰島素敏感度指標QUICKI、McAuley，則與骨質疏鬆症呈顯著負相關。隨著胰島素阻抗指標中HOMA-IR、HOMA2-IR增加，左側股骨頸、左側髖骨、腰椎的骨質密度均顯著下降，而胰島素敏感度指標QUICKI、McAuley與骨質密度則為顯著正相關。

結論 非糖尿病的50歲以上男性及停經後婦女，胰島素阻抗指數越高，伴隨較高的骨質疏鬆症風險與較低的三部位（左側股骨頸、左側髖骨、腰椎）骨質密度。因此，非糖尿病者若出現較高的胰島素阻抗，可能需要採取相關措施以預防未來骨質疏鬆症的發生。

Background Osteoporosis is a crucial issue in public health, and type 2 diabetes is one of the risk factors. It is known that type 2 diabetes patients have higher insulin resistance and higher risk of osteoporosis. However, currently there is no consensus on the relationship between insulin resistance (IR) and osteoporosis or bone mineral density (BMD) in nondiabetics. Hence, we aimed to explore the association between IR and osteoporosis as well as BMD in nondiabetics.

Methods We utilized a cross-sectional study design, including all participants from a health examination center in Taipei in 2023. The study subjects were nondiabetic men over 50 years old and postmenopausal women. Six indices of insulin resistance (or sensitivity) were used: Homeostatic model assessments (HOMA-IR, HOMA-β, HOMA2-IR, HOMA2-β), Quantitative insulin sensitivity check index (QUICKI) and McAuley. Logistic regression and linear regression models were employed to obtain multivariable adjusted odds ratios for osteoporosis and to access the associations between insulin resistance (or sensitivity) and BMD of the left femoral neck, left hip and lumbar spine.

Results A total of 2,202 individuals were included in the analysis. Among the IR indices, HOMA-IR and HOMA2-IR were positively associated with osteoporosis significantly (aOR for HOMA2-IR 1.16 (95% CI 1.01-1.32)), but the insulin sensitivity (IS) indices QUICKI and McAuley were negatively associated with osteoporosis significantly. As HOMA-IR and HOMA2-IR increased, BMD in the left femoral neck, left hip and lumbar spine significantly decreased, while QUICKI and McAuley were positively associated with BMD significantly.

Conclusion In nondiabetic men over 50 years old and postmenopausal women, higher IR is associated with a higher risk of osteoporosis and lower BMD in the left femoral neck, left hip and lumbar spine. As a result, preventive strategies are necessary in nondiabetic individuals with higher insulin resistance to against future osteoporosis.