Clinical Manifestations and Risk Factors of Osteoporosis in Patients with Type 2 Diabetes Mellitus

To investigate the clinical manifestations and modifiable risk factors of osteoporosis in patients with type 2 diabetes mellitus (T2DM), with emphasis on the interplay between metabolic dysregulation, inflammation, and bone health.

This retrospective cohort study included 241 middle-aged and older T2DM patients from the Second Affiliated Hospital of Army Medical University (2016-2020). The participants underwent dual-energy X-ray absorptiometry for bone mineral density (BMD) assessment. Osteoporosis was defined as a BMD T-score of ≤ -2.5. Data on demographic, anthropometric, metabolic, inflammatory, and bone turnover marker levels were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. Restricted cubic spline (RCS) and receiver operating characteristic (ROC) curves were used to evaluate nonlinear associations and predictive accuracy.

Of 241 patients, those with osteoporosis were significantly older (64.1 vs 59.0, p = 0.021) and more likely female. Lower body mass index (BMI), higher total cholesterol (TCH), elevated N-terminal mid-fragment of osteocalcin (N-MID), elevated high-density lipoprotein cholesterol (HDL-C), and lower monocyte-to-HDL ratio (MHR) and platelet-to-HDL ratio (PHR) were significantly associated with osteoporosis (p = 0.015, 0.024, 0.019, 0.013, 0.027, and 0.039, respectively). Multivariate analysis revealed that advanced age (odds ratio [OR] = 1.036, p = 0.020), low BMI (OR = 0.897, p = 0.017), and elevated TCH levels (OR = 1.381, p = 0.021) were independently associated with an increased risk of osteoporosis. Although HDL-C levels and MHR showed initial associations, they lost significance after adjustment. RCS showed a linear correlation between BMI and osteoporosis risk in patients with T2DM (p for overall = 0.020; p for nonlinear = 0.351). ROC analysis showed modest predictive power for individual markers (AUC < 0.60); however, a composite model (including age, sex, BMI, TCH, HDL-C, and MHR) improved the AUC to 0.692.

In T2DM patients, age, low BMI, and elevated TCH were independent risk factors for osteoporosis. Routine inflammatory indices showed limited predictive value. A multimodal model integrating demographic and metabolic factors offers better predictive accuracy, supporting a comprehensive risk assessment in clinical practice.