Feng Dehuai, Liu Junying, Bai Ningning, Chen Shujuan, Zhou Liming, He Xinlian, Zhao Keli, Wang Shaobin, Wan Jinyang, Ouyang Sheng, Zheng Yiting, Cai Zhimao, Yan Dewen, Chen Ling
Department of Endocrinology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen Center for Diabetes Control and Prevention, Shenzhen, 518035, China.
Western Institute of Health Data Science, Chongqing, 401329, China.
Diabetol Metab Syndr. 2025 May 29;17(1):177. doi: 10.1186/s13098-025-01740-6.
Type 2 diabetes (T2D) correlates with an elevated risk of osteoporotic fractures. However, factors influencing bone mineral density (BMD) and trabecular bone score (TBS) in Chinese individuals with T2D remain unclear. This study aimed to investigate the clinical and biochemical determinants of BMD and TBS in patients with T2D, with a focus on elucidating the role of weight-adjusted waist index (WWI) in modulating bone mass and quality in this cohort.
Data of 161 women and 153 men with T2D collected between July 2022 and March 2023 in Shenzhen, China, were analyzed in our cross-sectional study. Lumbar spine BMD and TBS of all participants were obtained using dual-energy X-ray absorptiometry. WWI was defined as waist circumference over the square root of weight.
Multivariate regression analysis demonstrated that lumbar spine TBS was inversely correlated with age, menopausal status, and WWI in women (p < 0.05). In men, TBS was negatively associated with age and WWI (p < 0.05). For women, glycated hemoglobin A1c positively influenced BMD (p < 0.05), whereas age, diabetic retinopathy, and N-mid osteocalcin were negatively associated. No significant predictors of BMD were identified in the male cohort. For predicting degraded TBS, the optimal WWI cut-offs were 11.257 cm/√kg (S: 61.1%, E: 80.7%) in males and 11.247 cm/√kg (S: 70.3%, E: 71.1%) in females.
Our findings highlight WWI as a novel and potentially more precise indicator of body fat, associated with diminished bone quality rather than solely low bone mass in patients with T2D in China. These results suggest that evaluating bone health in individuals with higher WWI may require more than just bone mass assessment. The results also suggest that the optimal WWI cut-off points for predicting degraded TBS are approximately 11.25 cm/√kg, highlighting thresholds for fracture risk.
2型糖尿病（T2D）与骨质疏松性骨折风险升高相关。然而，影响中国T2D患者骨密度（BMD）和小梁骨评分（TBS）的因素仍不清楚。本研究旨在调查T2D患者BMD和TBS的临床及生化决定因素，重点阐明体重调整腰围指数（WWI）在调节该队列人群骨量和骨质量中的作用。
在我们的横断面研究中，分析了2022年7月至2023年3月在中国深圳收集的161名患有T2D的女性和153名患有T2D的男性的数据。所有参与者的腰椎BMD和TBS均使用双能X线吸收法获得。WWI定义为腰围除以体重的平方根。
多因素回归分析表明，女性腰椎TBS与年龄、绝经状态和WWI呈负相关（p<0.05）。在男性中，TBS与年龄和WWI呈负相关（p<0.05）。对于女性，糖化血红蛋白A1c对BMD有正向影响（p<0.05），而年龄、糖尿病视网膜病变和N-端骨钙素呈负相关。在男性队列中未发现BMD的显著预测因素。对于预测TBS降低，男性的最佳WWI切点为11.257 cm/√kg（敏感度：61.1%，特异度：80.7%），女性为11.247 cm/√kg（敏感度：70.3%，特异度：71.1%）。
我们的研究结果突出了WWI作为一种新的、可能更精确的体脂指标，与中国T2D患者骨质量下降相关，而不仅仅是骨量低。这些结果表明，评估WWI较高个体的骨骼健康可能需要的不仅仅是骨量评估。结果还表明，预测TBS降低的最佳WWI切点约为11.25 cm/√kg，突出了骨折风险阈值。
