The relationship between type 2 diabetes mellitus, prediabetes, and bone mineral density in middle-aged and older adults: a nationwide study.

Abstract

This retrospective analysis of 11,595 individuals aged ≥ 50 years from the Taiwan Biobank demonstrated that prediabetes and type 2 diabetes mellitus (T2DM) were associated with higher bone mineral density (BMD). Prolonged T2DM duration correlated with increased lumbar spine BMD, while its effect on femoral neck BMD was nonsignificant after adjusting for confounding factors.

Purpose: The relationship between T2DM, prediabetes and BMD has remained uncertain due to conflicting findings in previous research. This study aims to investigate the association between T2DM, prediabetes and BMD among middle-aged and older adults with Taiwan Biobank database.

Methods: The retrospective study included 11,595 patients aged ≥ 50 years from the Taiwan Biobank (2012-2021), comprising 2,476 in the control group, 6,877 in the prediabetes group, and 2,242 in the T2DM group. Categorical variables were analyzed with Pearson's chi-square, and continuous data was obtained using the Mann-Whitney U test. Significant variables (p < 0.05) in the univariate analysis were included in a multivariate logistic regression analysis. Patients with T2DM or prediabetes exhibited higher BMD at all measured sites compared to controls (p < 0.001).

Results: Multivariable analysis demonstrated that both conditions were independently associated with a lower osteoporosis rate. Individuals with T2DM for > 10 years had higher lumbar spine BMD compared to those with T2DM for 5-10 or < 5 years. However, T2DM duration > 10 years was associated with lower BMD at the bilateral femoral necks compared to those with a duration of 5-10 years. After adjusting for confounders, diabetes duration ≥ 10 years was no longer a significant predictor of lower femoral neck BMD. In the normal-weight category, individuals with T2DM had a significantly lower prevalence of osteoporosis than those with prediabetes and controls (p < 0.001). This inverse association was not observed in the underweight, overweight, or obese groups.

Conclusions: Prediabetes and T2DM are correlated with higher BMD in middle-aged and older adults. A longer T2DM duration is associated with increased BMD at the lumbar spine but not the femoral neck after adjusting for confounders.