中西医协同治疗2型糖尿病合并骨质疏松症的研究现状与展望

Research Status and Prospects of Collaborative Treatment of Type 2 Diabetes Mellitus Combined with Osteoporosis Using Traditional Chinese Medicine and Western Medicine

摘要: 2型糖尿病(T2DM)与骨质疏松症(OP)是两种危害严重的慢性代谢性疾病，其共病状态——糖尿病性骨质疏松症(DOP)显著增加患者骨折风险及疾病负担，已成为临床与公共卫生领域关注的重要问题。现代医学研究表明，DOP的发病机制涉及高糖毒性、晚期糖基化终产物堆积、慢性炎症、氧化应激及药物影响等多重病理环节的交互作用。治疗上强调综合管理，包括生活方式干预、基础营养补充、个体化降糖方案及规范的抗骨质疏松药物治疗。中医学将本病归属于“消渴”合并“骨痿”范畴，其核心病机为“脾肾两虚为本，瘀血阻络为标”。治疗上以补肾健脾、活血通络为基本原则，通过中药复方、中成药、针灸及传统功法等多种方法进行整体调节与辨证施治。中西医结合治疗融合了两种医学体系的优势，构建了病证结合、标本兼治的协同诊疗模式，该模式在提高骨密度、改善糖脂代谢、缓解临床症状及减少西药潜在副作用方面展现出“增效减毒”的协同价值与良好的应用前景。本文通过系统梳理相关进展，以期为DOP的深入研究与临床实践提供有益的思路与参考。

Abstract: Type 2 diabetes mellitus (T2DM) and osteoporosis (OP) are two severe and chronic metabolic disorders. Their co-occurrence, diabetic osteoporosis (DOP), significantly increases patients’ risk of fractures and disease burden, making it an important issue of concern in both clinical and public health fields. Modern medical research has shown that the pathogenesis of DOP involves the interaction of multiple pathological mechanisms, including high glycemic toxicity, accumulation of advanced glycosylation end-products, chronic inflammation, oxidative stress, and drug effects. Treatment emphasizes comprehensive management, including lifestyle interventions, basic nutritional supplements, individualized glucose-lowering regimens, and standardized anti-osteoporosis medications. Traditional Chinese medicine categorizes this condition as “xiao ke” combined with “gu wei”, with the core pathogenesis being “kidney and spleen deficiency as the root cause, and blood stasis obstructing the meridians as the manifestation”. Treatment focuses on tonifying the kidneys and spleen, promoting blood circulation, and resolving blood stasis. Holistic regulation and syndrome differentiation are achieved through various methods such as herbal formulations, Chinese patent medicines, acupuncture, and traditional exercises. The integration of traditional Chinese medicine and Western medicine combines the strengths of both systems, creating a collaborative diagnostic and treatment model that addresses both the root cause and the symptoms. This model demonstrates synergistic value in enhancing bone density, improving glycemic and lipid metabolism, alleviating clinical symptoms, and reducing the potential side effects of Western medications, offering promising application prospects. By systematically reviewing relevant progress, this article aims to provide useful insights and references for the further study and clinical practice of DOP.