Clinical and Laboratory Predictors of Bone Mineral Density Trajectories and Osteoporosis Progression: A Retrospective Longitudinal Cohort Study

Clinical characteristics of the reduced bone mineral density subgroup among adults with type 2 diabetes mellitus: a retrospective cross-sectional study

Skeletal fragility in type 2 diabetes mellitus (T2DM) is incompletely represented by areal bone mineral density (BMD). We defined an operational reduced-BMD subgroup using routine hospital information-system data and examined whether routinely available clinical variables showed incremental associations and whether complex classifiers improved internal discrimination beyond age and sex. This single-center retrospective cross-sectional analysis included 329 de-identified analytical records from adults with T2DM who underwent routine dual-energy X-ray absorptiometry. The operational reduced-BMD subgroup was defined by the lowest T-score among the lumbar spine L1-L4, femoral neck, and total hip: records with at least one site-specific T-score ≤ − 1.0 were classified into the subgroup, and a stricter < -1.0 definition was examined as a boundary sensitivity analysis. Because menopausal status and Z-scores were unavailable, this rule was treated as an operational subgroup definition rather than a universal clinical diagnosis. Descriptive analyses, deliberately parsimonious Jeffreys-prior bias-reduced logistic models, fixed-unit age sensitivity analyses, and repeated nested internal classification were performed. Twenty-six records (7.9%) met the primary operational definition and 22 met the stricter definition; no record met a T-score ≤ − 2.5 threshold at the retained primary sites. Twenty-five of the 26 records in the reduced-BMD subgroup were from women. In the prespecified full-cohort model, age had an odds ratio (OR) of 5.39 per within-sample standard deviation (95% profile-likelihood confidence interval [CI], 2.71–12.15), and the female-sex estimate was large but imprecise (OR, 34.47; 95% CI, 8.29-321.11). On a common five-year scale, the age OR was 2.33 (95% CI, 1.65–3.50) in the full cohort and 2.29 (95% CI, 1.60–3.47) among records aged ≥ 50 years. The fixed age-sex classifier had a median internally validated ROC AUC of 0.921 (range, 0.915–0.923), decreasing to 0.901 (range, 0.897–0.904) in the age ≥ 50 subset. Among the tested algorithms and prespecified features, no complex classifier materially exceeded the fixed age-sex benchmark. In this selected single-center record-level dataset, the operational reduced-BMD subgroup was characterized principally by older age and marked female predominance. Restriction to age ≥ 50 years reduced apparent discrimination because of narrower case mix, while the age association remained similar on a fixed five-year scale. The additional tested variables did not provide precisely estimated incremental associations in the prespecified age-sex-plus-one-variable models, and the tested complex classifiers did not materially improve internal discrimination over the age-sex benchmark. All classification estimates were internally validated only, and the findings do not support causal, diagnostic, prognostic, deployment, or treatment claims. The operational reduced-BMD subgroup comprised 26 of 329 analytical records from adults with T2DM. Twenty-five of the 26 reduced-BMD records were from women, and all occurred at age ≥50 years. Jeffreys-prior bias-reduced logistic regression addressed sparse outcomes and near-separation. The age association was similar in the full cohort and the age ≥50 subset when expressed per five years. Within internal validation, the tested complex classifiers did not materially outperform the age-sex benchmark.

Retrospective Development and Internal Validation of a Diagnostic Model to Identify Secondary Osteoporosis in Community-Dwelling Older Men

The model integrates LS-BMD T-score, fall risk, Vitamin D, testosterone, testosterone, and glucocorticoid use, but external validation is required before clinical application, but decision curve analysis confirmed clinical net benefit.

Inverse association between high-density lipoprotein cholesterol and bone mineral density in patients with diabetes results from a nationally representative survey

Higher HDL levels were consistently and independently associated with lower BMD in US adults with diabetes, challenging the traditional view of HDL as universally protective and suggesting that in the diabetic context, elevated HDL may exert detrimental effects on bone health.

Baseline systolic blood pressure and longitudinal increase in HbA1c levels as predictors of bone mineral density in older men: a 4-year prospective study

Differential Impact of Type 1 Diabetes on Bone Outcomes in Children.

Objectives Type 1 diabetes (T1D) is a recognized risk factor for skeletal fragility in adults, but its impact on bone microstructure in children remains incompletely characterized. In particular, data on trabecular bone quality remain scarce. This study aimed to evaluate skeletal parameters in this group of children and examine their associations with clinical variables. Methods This retrospective cross-sectional study evaluated children with T1D at the Hong Kong Children's Hospital from June 2023 to December 2024. Skeletal parameters, including trabecular bone score (TBS), bone health index (BHI), bone mineral density (BMD) by dual-energy x-ray absorptiometry, and serum vitamin D and HbA1c levels, were evaluated alongside fracture history. A parent-reported questionnaire measured participation in physical activity. Correlations between bone parameters and clinical variables were analyzed. Results Sixty-eight children with T1D (male 42.6%, mean 12.7 ± 3.7 years, 44.1% prepubertal, mean HbA1c 7.3%) were included. A substantial proportion of children (19.6%) had low cortical bone density as reflected by BHI Z-score ≤ -2, whereas deficits in trabecular bone (TBS Z-score ≤ -2) were less common (4.8 %). Regression analysis confirmed that higher lean mass was associated with higher total body less head (TBLH), lumbar spine (LS) and TBS Z-scores (β=0.0001, p < 0.05), while disease duration had a negative association with these measurements (β=-0.1413; β =-0.1335, β=-0.2270, p < 0.05). Conclusion In this cohort of children with T1D, a pattern of skeletal involvement was observed, characterized by a high prevalence of low BHI Z-scores and a relatively low prevalence of low TBS Z-scores. This may suggest differential involvement of cortical bone with relative preservation of trabecular microarchitecture. Whether these structural differences translate into fracture risk remains unknown. Longitudinal studies are needed to elucidate the evolution of bone alterations over time and to identify determinants underlying skeletal vulnerability in childhood-onset diabetes. Higher lean mass was associated with higher bone mass and microarchitectural indices, whereas longer disease duration may have a negative association with these parameters. These findings highlight modifiable and disease-related factors that may influence bone health, warranting confirmation in larger controlled studies.

Cumulative Lifestyle Profiles and Osteoporotic Fracture Risk in Older Women: A Nationwide Korean Cohort Study

Background/Objectives: Modifiable lifestyle behaviors may be relevant to osteoporotic fracture risk, but their cumulative association across different levels of skeletal health remains unclear. This study investigated the association between a cumulative lifestyle score and osteoporotic fracture risk according to baseline bone mineral density (BMD) category in older women. Methods: We conducted a nationwide retrospective cohort study using Korean National Health Insurance Service data from 541,770 women aged 66 years who underwent dual-energy X-ray absorptiometry through the national life-transition health screening program between 2010 and 2016. A cumulative lifestyle score ranging from 0 to 3 was constructed by assigning one point each for regular exercise, non- or ex-smoking status, and non-drinking status. Cox proportional hazards models were used to evaluate associations with any, vertebral, hip, and other osteoporotic fractures across normal BMD, osteopenia, and osteoporosis groups. Results: Higher lifestyle scores were generally associated with lower osteoporotic fracture hazards across BMD categories. For any fracture, the adjusted hazard ratios for lifestyle score 3 versus 0 were 0.746 (95% CI, 0.564–0.987) in the normal BMD group, 0.747 (95% CI, 0.630–0.885) in the osteopenia group, and 0.786 (95% CI, 0.668–0.924) in the osteoporosis group. No statistical evidence of interaction between lifestyle score and BMD category was observed. The incidence-rate differences between scores 0 and 3 for any fracture were 4.49, 6.03, and 5.99 per 1000 person-years in the normal BMD, osteopenia, and osteoporosis groups, respectively. Conclusions: A more favorable cumulative lifestyle profile was associated with lower osteoporotic fracture risk across BMD categories in older women. Although there was no statistical evidence that the relative associations differed by BMD category, larger incidence-rate differences were observed among women with lower BMD. These observational findings support the potential value of integrated lifestyle assessment as a complementary component of fracture-risk assessment and counseling.