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Positive causal association between diabetes and osteomyelitis, mediated by glycosylated hemoglobin and BMI: Evidence

Ke Zhang1, Maosen Geng, Peiwu Zhang

  • 1Department of Orthopedic, Xi'an Central Hospital, Xi'an, Shaanxi, China.

Medicine
|March 11, 2025
PubMed

Insights

Diabetes mellitus (DM) increases osteomyelitis (OM) risk. This study confirms a causal link, finding that elevated HbA1c and BMI mediate this relationship, offering insights into disease prevention.

Area of Science:

  • Genetics and Epidemiology
  • Metabolic Disorders
  • Infectious Diseases

Background:

  • Diabetes mellitus (DM) is a prevalent metabolic disorder associated with increased susceptibility to infections.
  • Osteomyelitis (OM), a bone infection, occurs more frequently in individuals with DM.
  • Understanding the causal relationship and mediating factors is crucial for clinical management.

Purpose of the Study:

  • To establish a causal association between type 1 diabetes (T1D) and type 2 diabetes (T2D) and osteomyelitis (OM) using Mendelian randomization (MR).
  • To investigate potential mediating factors, including glycosylated hemoglobin (HbA1c), fructosamine, and body mass index (BMI), in the DM-OM relationship.

Main Methods:

  • Two-sample Mendelian randomization (TSMR) analysis was employed to assess causality.
  • Genome-wide association study data from FinnGen and the European Bioinformatics Institute were utilized.
  • Inverse variance weighting was the primary analytical method, with mediation MR analysis for mediators.

Main Results:

  • TSMR analysis indicated a significant positive causal effect of DM on OM risk (e.g., T2D(FINN) OR=1.389, P<.001; T1D(FINN) OR=1.140, P=.042).
  • Mediation analysis revealed that HbA1c and BMI significantly mediate the relationship between DM and OM (e.g., HbA1c in T1D-OM OR=1.379, P<.001; BMI in T2D-OM OR=1.788, P<.001).

Conclusions:

  • This MR study provides robust evidence for a causal link between both T1D and T2D and OM in a European population.
  • Glycosylated hemoglobin (HbA1c) and body mass index (BMI) act as significant mediators, highlighting their role in the DM-associated OM risk.

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