Comparison of Bone Microarchitecture and Clinical Biomarkers between Diabetic and Non-Diabetic Postmenopausal Osteoporotic Women

Abstract

Background: To characterize skeletal and metabolic profiles in postmenopausal women with osteoporosis, type 2 diabetes mellitus (T2DM), their coexistence (T2DM+osteoporosis), and healthy controls using biochemical markers, dual energy X-ray absorptiometry (DXA), and high-resolution peripheral quantitative computed tomography (HR-pQCT). Methods: This cross-sectional study included 220 postmenopausal women (60 each in osteoporosis, T2DM, and T2DM+osteoporosis groups; 40 controls). Participants underwent biochemical, endocrine, and hematological profiling, DXA of the spine and hip, and HR-pQCT imaging at the distal radius and tibia. Bone turnover markers (propeptide of type I collagen, C-terminal telopeptide), parathyroid hormone, and 25-hydroxy-vitamin D were assessed. Data were analyzed using analysis of variance and correlation analyses. Results: The osteoporosis and T2DM+osteoporosis groups demonstrated significantly lower areal bone mineral density (BMD), elevated bone turnover markers, and marked deterioration in cortical and trabecular microarchitecture. In contrast, T2DM participants exhibited preserved or higher BMD but showed microarchitectural alterations on HR-pQCT. Significant inverse correlations between DXA and HR-pQCT parameters were observed in osteoporosis and T2DM+osteoporosis groups, whereas such associations were not evident in T2DM. Conclusions: Distinct skeletal phenotypes were observed across osteoporosis, T2DM, and T2DM+osteoporosis. HR-pQCT identified structural deficits not captured by DXA, highlighting that microarchitectural assessment may provide additional insights beyond areal BMD; however, these findings are associative and hypothesis-generating.