Assessment of P1NP and β-CTX in Type 2 Diabetes Mellitus: a Case-Control Study from North India

Type 2 diabetes mellitus (T2DM) is associated with increased skeletal fragility despite normal or elevated bone mineral density (BMD), suggesting impaired bone quality and remodeling. Bone turnover markers (BTMs), including procollagen type I N-terminal propeptide (P1NP) and β-C-terminal telopeptide of type I collagen (β-CTX), reflect bone formation and resorption, respectively. This study evaluated serum P1NP and β-CTX concentrations in patients with T2DM from North India and their associations with clinical and biochemical parameters.

This hospital-based case-control study included 80 patients with T2DM and 20 age- and sex-matched healthy controls. Anthropometric measurements, glycemic indices, lipid profile, serum calcium, 25-hydroxyvitamin D, BMD and serum BTMs were assessed.

Patients with T2DM had significantly higher body mass index, blood pressure, fasting glucose, HbA1c and adverse lipid profiles than controls (all p<0.05). Serum β-CTX (0.735±0.302 vs. 0.356±0.171 pg/mL; p<0.001) and P1NP (33.11±16.49 vs. 26.39±10.92 ng/mL; p=0.033) were elevated in T2DM. Vitamin D levels were lower and osteoporosis was present in 76.3% of patients. β-CTX showed a weak inverse correlation with age (r=-0.233, p=0.038) and age remained its only independent predictor.

Patients with T2DM exhibited increased bone turnover with predominant bone resorption, supporting the clinical utility of BTMs beyond BMD assessment.