Sex-Stratified Association of Serum Uric Acid With Multisite Bone Mineral Density Among Inpatients With Type 2 Diabetes: A Cross-Sectional Study.

Abstract

Objective: This study sought to investigate the correlation between serum uric acid (SUA) levels and bone mineral density (BMD) among patients with Type 2 diabetes mellitus (T2DM).

Methods: A single-center retrospective cross-sectional analysis was performed. A total of 249 hospitalized patients with T2DM (147 men and 102 postmenopausal women) were recruited from Zhongshan Hospital (Xiamen), Fudan University, between June 2024 and June 2025. Baseline clinical characteristics were first compared between patients with normal BMD and those with osteopenia or osteoporosis. All participants were subsequently stratified into a normal uric acid (NUA) group and a hyperuricemia (HUA) group based on SUA concentrations. BMD measurements at the femoral neck, total hip, and lumbar spine were compared across the two groups. Multivariate logistic regression analysis was applied to determine independent factors associated with the risk of osteopenia and osteoporosis.

Results: Of the 249 enrolled participants, 178 (71.5%) were diagnosed with osteopenia or osteoporosis. Relative to patients with normal BMD, individuals with osteopenia/osteoporosis were older, had a higher proportion of female cases, exhibited elevated osteocalcin (OCN) levels and increased fracture risk, and presented significantly lower body mass index (BMI), estradiol (E2), and SUA levels. In the overall cohort, as well as in male and postmenopausal female subgroups, higher SUA levels were significantly and positively correlated with higher BMD at all three skeletal sites (all p < 0.05). Multivariate logistic regression demonstrated that OCN served as an independent risk factor for osteopenia and osteoporosis, whereas BMI, E2, and SUA served as independent protective factors against these bone disorders (all p < 0.05).

Conclusion: Elevated SUA levels are correlated with higher BMD and a reduced risk of osteopenia and osteoporosis in T2DM patients. BMI, E2, OCN, and SUA act as independent predictors of bone status in this patient population. Routine SUA testing may facilitate the identification of T2DM patients at high risk of osteopenia and osteoporosis.