Glycated hemoglobin and bone mineral density in adults with and without type 2 diabetes: a cross-sectional DXA study from the Qassim region, Saudi Arabia
Higher HbA1c levels were associated with lower bone mineral density categories in an exploratory regression model adjusted for the variables included in the analysis and support further investigation of the relationship between glycaemic control and bone health in larger prospective studies with comprehensive adjustment for clinical confounders.
Abstract
This comparative cross-sectional study evaluated bone mineral density (BMD) and its association with glycemic control and biochemical bone markers among adults with and without type 2 diabetes mellitus (T2DM) in the Qassim region, Saudi Arabia. A comparative cross-sectional study was conducted among 73 adults (comprising individuals with T2DM and non-diabetic controls) recruited from healthcare facilities in the Qassim region, Saudi Arabia. Clinical, demographic, and bone health data were collected using a structured questionnaire and hospital medical records. Glycated hemoglobin (HbA1c), serum calcium, alkaline phosphatase (ALP), fracture history, and bone mineral density were evaluated. BMD was measured at the lumbar spine and femoral neck using dual-energy X-ray absorptiometry (DXA) and classified according to the World Health Organization (WHO) criteria. Statistical analyses were performed using SPSS version 23.0. T2DM was diagnosed in 69.9% of participants; 48.0% had osteopenia and 19.2% had osteoporosis. Chronological age was associated with progressive bone mineral density loss across successive cohorts (Pearson χ² = 11.14, p = 0.025). Among participants with T2DM, mean HbA1c increased progressively with longer diabetes duration (Spearman’s rho = 0.310, p = 0.027). In an exploratory multinomial logistic regression model, higher HbA1c was associated with lower bone mineral density categories each 1% increase in HbA1c was associated with higher odds of osteopenia (adjusted odds ratio [aOR] = 2.34, 95% confidence interval [CI]: 1.12–4.88; p = 0.024) and osteoporosis (aOR = 3.89, 95% CI: 1.45–10.42; p = 0.007). Serum calcium and alkaline phosphatase (ALP) were not significantly associated with bone mineral density. Low bone mineral density was common in this study population. Higher HbA1c levels were associated with lower bone mineral density categories in an exploratory regression model adjusted for the variables included in the analysis. These findings support further investigation of the relationship between glycaemic control and bone health in larger prospective studies with comprehensive adjustment for clinical confounders.
Objective This study sought to investigate the correlation between serum uric acid (SUA) levels and bone mineral density (BMD) among patients with Type 2 diabetes mellitus (T2DM). Methods A single‐center retrospective cross‐sectional analysis was performed. A total of 249 hospitalized patients with T2DM (147 men and 102 postmenopausal women) were recruited from Zhongshan Hospital (Xiamen), Fudan University, between June 2024 and June 2025. Baseline clinical characteristics were first compared between patients with normal BMD and those with osteopenia or osteoporosis. All participants were subsequently stratified into a normal uric acid (NUA) group and a hyperuricemia (HUA) group based on SUA concentrations. BMD measurements at the femoral neck, total hip, and lumbar spine were compared across the two groups. Multivariate logistic regression analysis was applied to determine independent factors associated with the risk of osteopenia and osteoporosis. Results Of the 249 enrolled participants, 178 (71.5%) were diagnosed with osteopenia or osteoporosis. Relative to patients with normal BMD, individuals with osteopenia/osteoporosis were older, had a higher proportion of female cases, exhibited elevated osteocalcin (OCN) levels and increased fracture risk, and presented significantly lower body mass index (BMI), estradiol (E2), and SUA levels. In the overall cohort, as well as in male and postmenopausal female subgroups, higher SUA levels were significantly and positively correlated with higher BMD at all three skeletal sites (all p < 0.05). Multivariate logistic regression demonstrated that OCN served as an independent risk factor for osteopenia and osteoporosis, whereas BMI, E2, and SUA served as independent protective factors against these bone disorders (all p < 0.05). Conclusion Elevated SUA levels are correlated with higher BMD and a reduced risk of osteopenia and osteoporosis in T2DM patients. BMI, E2, OCN, and SUA act as independent predictors of bone status in this patient population. Routine SUA testing may facilitate the identification of T2DM patients at high risk of osteopenia and osteoporosis.
Shangjian Li, Weihong Lu, Xiumei Luo et al.· Journal of Diabetes Research· 0 citations
Type 1 diabetes mellitus patients showed a markedly higher prevalence of vertebral fractures and lower femoral neck BMD compared with healthy controls, suggesting a potential role of phosphate metabolism in diabetic bone fragility.
Hatice Gizem Günhan, Okan Çetin, Eren İmredrg et al.· Cerrahpasa Medical Journal· 0 citations
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.
Song Lu, Bo Wan, Chun-Sheng Qian et al.· BMC Musculoskeletal Disorder...· 0 citations
Older people with osteopenia, osteoporosis and fracture had lower visceral fat mass, lean mass, lean mass and waist circumference than normal people and LM, WC and VFM had the greatest effect on BMD and fracture in elderly diabetic.
Seyed Amirhossein Hosseini, N. Meftah, Mansor Babaei et al.· Caspian Journal of Internal...· 0 citations
To investigate the association between the Metabolic Score for Insulin Resistance (METS-IR) and bone mineral density (BMD) and trabecular bone score (TBS) in adult cancer patients.
This cross-sectional study enrolled 127 patients (median age 63 years, 44.9% female) with histopathologically confirmed malignancies. BMD at the lumbar spine, femoral neck, and total hip and lumbar spine TBS were measured by dual-energy X-ray absorptiometry. METS-IR was calculated using fasting glucose, triglycerides, high-density lipoprotein cholesterol, and body mass index. Multivariable linear regression was used to identify independent associations.
After adjustment for confounders, METS-IR was independently and positively associated with BMD at lumbar spine (β = 0.006, 95% CI 0.002–0.011, P = 0.007), femoral neck (β = 0.007, 95% CI 0.003–0.011, P < 0.001), and total hip (β = 0.007, 95% CI 0.003–0.010, P < 0.001). Age was inversely associated with lumbar spine and femoral neck BMD, but not with total hip BMD; bone metastasis was linked to higher lumbar spine and total hip BMD. In contrast, METS-IR showed no significant association with lumbar spine TBS (P = 0.374). For TBS, age and male sex, but not METS-IR, were independent determinants.
In cancer patients, higher METS-IR is independently associated with greater BMD but not with better trabecular microarchitecture. This discordance between bone quantity and quality suggests that insulin resistance may mask impaired bone quality despite preserved BMD. Clinicians should consider bone quality assessments when evaluating fracture risk in metabolically compromised cancer patients. Longitudinal studies are warranted to confirm these findings.
Hong-Dan Yao, Cheng Niu, Lin Zhu et al.· Frontiers in Endocrinology· 0 citations
The CVD and non-CVD groups did not differ in awareness or treatment rates, suggesting that cardiovascular follow-up does not facilitate osteoporosis detection and Multivariable logistic regression identified predictors of unawareness and non-treatment.
D. Choi, J. Ryu· Archives of Osteoporosis· 0 citations
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