Lu HL, Yu F, Zhou HF, Hu P, Gan SL. Clinical significance of bone metabolic markers in osteoporosis-complicated type 2 diabetes mellitus and risk determinants: A retrospective study. World J Diabetes 2026; 17(8): 123389 [DOI: 10.4239/wjd.123389]
Corresponding Author of This Article
Sheng-Lian Gan, Chief Physician, Department of Endocrinology and Metabolism, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), No. 388 Renmin East Road, Changde 415003, Hunan Province, China. ganshenglian03@126.com
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Lu HL, Yu F, Zhou HF, Hu P, Gan SL. Clinical significance of bone metabolic markers in osteoporosis-complicated type 2 diabetes mellitus and risk determinants: A retrospective study. World J Diabetes 2026; 17(8): 123389 [DOI: 10.4239/wjd.123389]
World J Diabetes. Aug 15, 2026; 17(8): 123389 Published online Aug 15, 2026. doi: 10.4239/wjd.123389
Clinical significance of bone metabolic markers in osteoporosis-complicated type 2 diabetes mellitus and risk determinants: A retrospective study
Hui-Lin Lu, Fang Yu, Hai-Feng Zhou, Ping Hu, Sheng-Lian Gan
Hui-Lin Lu, Fang Yu, Hai-Feng Zhou, Ping Hu, Sheng-Lian Gan, Department of Endocrinology and Metabolism, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415003, Hunan Province, China
Author contributions: Lu HL participated in the study design, and wrote and revised the manuscript; Lu HL and Gan SL conducted the design of the study and reviewed/edited the drafts, and are guarantors; Lu HL, Yu F, Zhou HF, and Hu P collected and analyzed the data. All authors contributed to the article and approved the submitted article.
AI contribution statement: The authors declare that no AI tools were used in the development or writing of this manuscript and take full responsibility for its integrity, accuracy, and originality.
Institutional review board statement: This study was approved by the Ethic Committee of The First People’s Hospital of Changde City. No. 2026-298-01.
Informed consent statement: Due to the retrospective and de-identified nature of this study, written informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Corresponding author: Sheng-Lian Gan, Chief Physician, Department of Endocrinology and Metabolism, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), No. 388 Renmin East Road, Changde 415003, Hunan Province, China. ganshenglian03@126.com
Received: May 22, 2026 Revised: July 7, 2026 Accepted: July 31, 2026 Published online: August 15, 2026 Processing time: 74 Days and 22.8 Hours
Abstract
BACKGROUND
The prevalence of osteoporosis (OP) among individuals with type 2 diabetes mellitus (T2DM) has increased significantly, markedly elevating the risk of fragility fractures.
AIM
To investigate the clinical significance of bone metabolic markers (BMMs) in patients with T2DM with comorbid OP and identified associated risk determinants.
METHODS
A total of 215 patients with T2DM, with (OP group) or without (non-OP group) OP, who attended The First People’s Hospital of Changde City between May 2021 and July 2025 were enrolled. The levels of BMMs were compared between the OP and non-OP groups. Using dual-energy X-ray absorptiometry as the gold standard for OP diagnosis, the correlations between BMMs and OP comorbidity in T2DM were evaluated. The risk determinants were subsequently identified.
RESULTS
Significant intergroup differences were observed in age and glycosylated hemoglobin (P < 0.05), whereas alkaline phosphatase, high-density lipoprotein cholesterol, 1,25-dihydroxyvitamin D3, blood phosphorus, blood calcium, total cholesterol, triglyceride, or low-density lipoprotein cholesterol levels did not differ significantly (P > 0.05). Sex and smoking/drinking history were also comparable between groups (P > 0.05). Parathyroid hormone (PTH) and β-C-terminal telopeptide of type I collagen levels were significantly higher in T2DM patients with OP than in those without OP (P < 0.05). The two groups showed no significant differences in DM duration, comorbid diseases, peripheral neuropathy, and fasting blood glucose (P > 0.05). Age and PTH emerged as independent risk determinants for OP comorbidity in T2DM (P < 0.05).
CONCLUSION
Elevated PTH levels in T2DM patients with comorbid OP suggest that PTH provides valuable guidance for OP diagnosis in this population. Age and PTH were independently associated with OP in T2DM.
Core Tip: Type 2 diabetes (T2DM) is associated with impaired bone quality and an increased risk of fractures. However, assessment based solely on bone density has important limitations. In this retrospective study, patients with T2DM and osteoporosis (OP) exhibited higher serum parathyroid hormone (PTH) and β-C-terminal telopeptide of type I collagen levels than those without OP, suggesting altered bone metabolism. Notably, PTH concentrations in the OP group were more than double those in the non-OP group and were accompanied by evidence of reduced skeletal responsiveness to PTH. Multivariate analysis further identified older age and elevated PTH levels as independent risk factors for OP comorbidity. These findings suggest that routine assessment of PTH and β-C-terminal telopeptide of type I collagen, combined with clinical evaluation, may facilitate the earlier identification of high-risk T2DM patients, thereby enabling early intervention before the occurrence of fragility fractures.
