Aug 2026· Cerrahpasa Medical Journal· 0 citations· 14 references
TL;DR
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.
Abstract
Objective: This study aimed to evaluate the relationship between vertebral fracture and various biological factors in patients with type 1 diabetes mellitus (T1DM).
Methods: The study included 61 patients diagnosed with T1DM who were evaluated in the Diabetes Outpatient Clinic between 2017 and 2019, and 49 healthy individuals forming the control group. Demographic and clinical characteristics (age, gender, hypertension, hyperlipidemia, obesity), biochemical parameters (fasting blood glucose, HbA1c, calcium, phosphate, parathyroid hormone, 25-OH vitamin D, C-terminal telopeptide, osteocalcin, alkaline phosphatase), and bone-related variables (L1–L4 and femoral neck bone mineral density [BMD], vertebral fracture status) were comprehensively collected during outpatient visits. Vertebral fractures were assessed by the Genant semi-quantitative method using lateral vertebral fracture assessment images obtained by dual-energy X-ray absorptiometry. Data were analyzed using non-parametric statistical tests and expressed as median (interquartile range). Logistic regression analysis adjusted for age, sex, body mass index (BMI), and phosphate levels was performed.
Results: Vertebral fracture prevalence was significantly higher in T1DM patients (67.2%) compared with controls (26.5%, P < .001). Patients had significantly lower body weight and BMI and higher rates of hyperlipidemia. Femoral neck BMD was significantly lower in the T1DM group (0.967 vs. 1.193 g/cm2, P < .001). Among diabetic patients, those with vertebral fractures had significantly lower serum phosphate levels than those without fractures (3.20 vs. 3.85 mg/dL, P = .008). No significant differences were observed in bone turnover markers or BMD values between patients with and without fractures.
Conclusion: Type 1 diabetes mellitus patients showed a markedly higher prevalence of vertebral fractures and lower femoral neck BMD compared with healthy controls. Lower phosphate levels were observed in patients with fractures, suggesting a potential role of phosphate metabolism in diabetic bone fragility.
Cite this article as: Günhan HG, .etin O, İmre E, Gogas Yavuz D. Bone mineral density and vertebral fracture frequency in a group of type 1 diabetic patients. Cerrahpaşa Med J. 2026, 50, 0091, doi: 10.5152/cjm.2026.25091.
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.
Tushar Kumar, Swapnajeet Sahoo, Richa Rattan et al.· Journal of Bone Metabolism· 0 citations
Age, number of operated vertebrae, cement leakage, PINP, 25(OH)D, and BMD are closely associated with and are independent risk factors for secondary fractures after PVP/PKP in OTF patients, and the nomogram model based on these factors has high value.
Jiawei Fu, Guan-Hua Xu, Jia-jia Chen et al.· Frontiers in Surgery· 0 citations
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.
H. Alharbi, A. Mohammed, Sahar Mohammed Alatni et al.· BMC Endocrine Disorders· 0 citations
Osteoporosis and osteopenia, prevalent metabolic bone disorders, increase fracture risk, particularly in postmenopausal women. Chronic inflammation may contribute to bone loss. The association between inflammatory indices and bone mineral density (BMD) was investigated.
A cross-sectional analysis involving 99 patients over the age of 40 at the Ilam Rheumatology Clinic (2019–2022) evaluated BMD using the Hologic Discovery Wi DXA and assessed blood indices with the Sysmex XN-1000. Statistical analyses, including T-tests, ANOVA, and Pearson’s correlation, were conducted utilizing SPSS version 16, with significance set at
P
< 0.05.
Among 99 patients (78.8% female, mean age 55.8 ± 9.7 years), the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) exhibited significant elevation in cases of osteoporosis (2.710 ± 0.610,
P
= 0.001) and osteopenia (2.230 ± 0.530,
P
= 0.001) than in normal BMD (1.840 ± 0.450). The BMD exhibited a negative correlation with the NLR (
r
= –0.430,
P
= 0.001) and the PLR (
r
= –0.370,
P
= 0.002). Patients with osteoporosis exhibited the lowest bone mineral density in the lumbar spine (
P
< 0.001).
Increased levels of NLR and PLR correlate with diminished BMD, suggesting their potential as cost-effective biomarkers for osteoporosis risk assessment. Monitoring these indices could enhance early diagnosis and prevention strategies in at-risk populations.
Nasrin Bazgir, MohammadHossein Sahami Gilan, Aliashraf Mozafari et al.· Journal of Education and Hea...· 0 citations
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
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.
S. W. Poon, Jian-Fang Zhu, Gloria S. W. Pang et al.· Journal of Clinical Research...· 0 citations
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