Chen Rensheng, Zhao Wei, Cai Pengfei, Peng Chao, Liu Hongxia
Department of Orthopedic, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, China.
Department of Orthopedic, People's Hospital of Tibet Autonomous Region, Lhasa, China.
J Orthop Surg (Hong Kong). 2025 May-Aug;33(2):10225536251356804. doi: 10.1177/10225536251356804. Epub 2025 Jul 1.
Osteoporosis (OP) is a common complication in patients with type 2 diabetes mellitus (T2DM), significantly increasing fracture risk and mortality. Body roundness index (BRI), a novel obesity assessment index, accurately reflects body fat distribution, but its relationship with OP risk in T2DM patients has not been clarified. The aim of this study was to investigate the nonlinear relationship between BRI and OP risk in patients with T2DM. In this study, based on data from the 2005-2018 National Health and Nutrition Examination Survey, we conducted a cross-sectional study involving 3,178 people with T2DM. Femoral bone mineral density was measured using dual-energy X-ray absorptiometry. Generalized additive model was used to assess the non-linear relationship between BRI and OP risk. Multiple logistic regression analyses were used to assess the relationship between BRI and OP risk, adjusted for various covariates. Subgroup analyses for age, sex, and ethnicity were also performed to assess the consistency and robustness of the results. Generalized additive model analyses demonstrated an L-shaped relationship between BRI and OP risk, and logistic regression analyses indicated that BRI exhibited a negative association with OP risk. The risk of OP exhibited a significant decrease with increasing BRI and appeared to saturate at a BRI of approximately 5.08. When the BRI was below 5.08, the risk of OP was reduced by 49% for each 1-unit increase (OR = 0.51, 95% CI: 0.37-0.71, < .001); However, when the BRI exceeded 5.08, the protective effect diminished and became statistically non-significant (OR = 0.99, 95% CI: 0.88-1.11, = .824). The log-likelihood ratio test demonstrated a significant model fit superiority ( < .001). Subgroup analyses and interaction tests demonstrated that this association remained stable across various demographic and socioeconomic groups, including age, sex, education, poverty-to-income ratio, exercise, and smoking. However, race had an interaction association with BRI and OP risk ( interaction < 0.050). Our study demonstrated that a negative association was found between BRI and OP risk in the United States population with T2DM and that this relationship was nonlinear. Further studies are needed to validate this.
骨质疏松症（OP）是2型糖尿病（T2DM）患者常见的并发症，会显著增加骨折风险和死亡率。身体圆润度指数（BRI）是一种新型肥胖评估指数，能准确反映身体脂肪分布，但它与T2DM患者OP风险之间的关系尚未明确。本研究旨在探讨T2DM患者中BRI与OP风险之间的非线性关系。在本研究中，基于2005 - 2018年美国国家健康与营养检查调查的数据，我们开展了一项横断面研究，纳入了3178名T2DM患者。使用双能X线吸收法测量股骨骨密度。采用广义相加模型评估BRI与OP风险之间的非线性关系。使用多元逻辑回归分析评估BRI与OP风险之间的关系，并对各种协变量进行了调整。还进行了年龄、性别和种族的亚组分析，以评估结果的一致性和稳健性。广义相加模型分析显示BRI与OP风险之间呈L形关系，逻辑回归分析表明BRI与OP风险呈负相关。随着BRI增加，OP风险显著降低，且在BRI约为5.08时似乎趋于饱和。当BRI低于5.08时，每增加1个单位，OP风险降低49%（OR = 0.51，95%CI：0.37 - 0.71，P <.001）；然而，当BRI超过5.08时，保护作用减弱且在统计学上无显著意义（OR = 0.99，95%CI：0.88 - 1.11，P =.824）。对数似然比检验显示模型拟合具有显著优势（P <.001）。亚组分析和交互作用检验表明，这种关联在包括年龄、性别、教育程度、贫困收入比、运动和吸烟等各种人口统计学和社会经济群体中保持稳定。然而，种族与BRI和OP风险存在交互作用关联（交互作用P < 0.050）。我们的研究表明，在美国T2DM人群中，BRI与OP风险之间存在负相关，且这种关系是非线性的。需要进一步研究来验证这一点。
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