The association between the AST/ALT ratio and osteopenia or osteoporosis in patients with type 2 diabetes mellitus.

INTRODUCTION

The aim of this study was to investigate the relationship between the AST/ALT ratio and osteopenia or osteoporosis in patients with type 2 diabetes mellitus (T2DM).

METHODS

A total of 589 patients with T2DM were divided into two groups based on T-score: T-score ≥ -1.0 group, normal bone mineral density and T-score < -1.0 group, osteopenia or osteoporosis (OP). The association between the AST/ALT ratio and osteopenia/OP was evaluated by multivariate analyses. The receiver operating characteristic (ROC) curves were used to estimate the diagnostic performance according to the area under the ROC curve (AUC).

RESULTS

The patients in the T-score < -1.0 group showed significantly higher AST/ALT level than those in the T-score ≥ -1.0 group (0.93 ± 0.16 vs 1.17 ± 0.24, P < 0.001). According to the interquartile range of the AST/ALT ratio, the participants were divided into four groups: Q1 (0.650, 0.874), Q2 (0.875, 0.999), Q3 (1.000, 1.173) and Q4 (1.174, 1.917). After adjustment for confounding factors, compared with Q1 of the AST/ALT level, subjects in Q3 and Q4 remained more likely to have osteopenia or osteoporosis (Q3, OR 3.478, 95% CI 1.641-7.411; Q4, OR 15.278, 95% CI 6.377-36.837). The AST/ALT ratio provided an AUC value of 0.81 (95% CI 0.77-0.84) for osteopenia or osteoporosis in patients with T2DM.

CONCLUSION

An elevated AST/ALT ratio is associated with the evaluated risk of osteopenia/OP in patients with T2DM. The AST/ALT ratio, a practical and cost-effective biomarker, may be a potential predictor of osteopenia/OP in patients with T2DM.