Risk Factors of Elderly Type 2 Diabetes Mellitus Complicated with Osteoporosis and Effects of Vitamin K1 on Bone Mineral Density and Insulin Resistance

Abstract

Aim: To analyze the bone mineral density (BMD) changes of type 2 diabetes mellitus (T2DM) after being complicated with osteoporosis (OP) and their correlations with multiple risk factors. Methods: 240 cases of elderly T2DM patients were divided into an OP group and a non-OP group according to the BMD values. The results were subjected to correlation analyses. Thereafter the 120 patients in the OP group were randomly divided into three groups to be treated with alfacalcidol (group A), vitamin K1 (group B) and alfacalcidol plus vitamin K1 (group C) continuously for 12 months. The BMD, FBG levels, fasting insulin (FINS) levels, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen (FIB) levels were measured 0, 6 and 12 months after administration. The heights, weights, BMI and HOMA-insulin resistance (HOMA-IR) of the patients were measured by designated personnel. Results: The patients in the OP group were of older age, longer disease course, lower BMD, and higher serum phosphorus than those in the non-OP group. The results of the two groups differed significantly (P< 0.05). The BMD of T2DM patients was negatively correlated with age, disease course, ALP and HbA1c and positively correlated with BMI. All the treatment methods elevated the BMD values of the three groups after 12 months (P<0.05 or P<0.01), and those of group C were elevated more significantly than those of group A and group B (P<0.05 or P<0.01). Although the number of lumbar vertebrae L1-L4 and ectotrochanter of group A patients were higher than that of group B patients after being treated for 3 months (P<0.01), the results of the two groups did not differ significantly (P> 0.05) 12 months after treatment. Conclusions: Old age, low BMI, long disease course, poor blood glucose control and high serum ALP are the risk factors leading to T2DM complicated with OP. However, vitamin K1, which increased the BMD of T2DM patients and boosted insulin resistance, could be combined with alfacalcidol and calcium supplement owing to the lack of abnormal blood clotting mechanism after long-term administration.