Correlation Analysis Between Abdominal Fat Distribution And Bone Mineral Density And Bone Turnover Markers In Patients With Type 2 Diabetes Mellitus

Objective:To analyze the correlation between abdominal fat distribution and BMD and bone turnover markers in patients with type 2 diabetes.Methods:Basic clinical data were collected from 104 patients with type 2 diabetes aged50 years or above who were admitted to the Department of Metabolism and Endocrinology of the Third Affiliated Hospital of Nanchang University from July2019 to November 2020.Fasting blood glucose(FPG)and 2 hours postprandial blood glucose(2h PG)were measured,uric acid(UA),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),bone alkaline phosphatase(BALP),glycosylated hemoglobin(Hb A1c),osteocalcin(OC),β-carboxy I terminal peptide(β-CTX)and type 1 procollagen N-terminal propeptide(PINP).DXA was used to measure the bone density of the lumbar spine(L1-L4)and the whole hip of the patients.Visceral fat area(VFA)and subcutaneous fat area(SFA)were measured using bioresistance.The patients were divided into three groups according to gender and VFA quartile: T1group(VFA < 68cm2)T2 group(68cm2 ≤ VFA < 95cm2)and T3 group(VFA≥95cm2).The general information,bone mineral density and bone turnover markers of the three groups were compared in the male and female groups respectively,and the correlation between abdominal fat and each index was analyzed.Result:1.Comparison of baseline characteristics of patients: lumbar BMD,total hip BMD,SFA,SUA,TG and HDL-C were statistically significant in males compared with females(P < 0.05).2.There were statistically significant differences in BMI,waist-hip ratio,VFA,SFA,PINP,TG,lumbar spine and total hip bone density among male groups(all P <0.05).There were statistically significant differences in BMI,waist-hip ratio,VFA,SFA,PINP,SUA,TC,LDL-C,lumbar spine and total hip bone density among female groups(all P < 0.05).Lumbar and hip BMD were the highest in T1 group and the lowest in T3 group for both men and women.3.Correlation analysis showed that in male T2 DM patients,VFA was positively correlated with age,BMI,waist-hip ratio,TG,and negatively correlated with PINP,lumbar spine,and total hip bone density.SFA was positively correlated with BMI and waist-hip ratio,while negatively correlated with OC and PINP(all P < 0.05).In female patients with T2 DM,VFA was positively correlated with BMI,waist-hip ratio,SUA,and LDL-C,and negatively correlated with PINP,lumbar spine,and total hip bone density.SFA was positively correlated with BMI,waist-hip ratio,LDL-C,and negatively correlated with OC(all P < 0.05).4.Lumbar and hip bone density were used as dependent variables,and age,BMI,waist-hip ratio,Hb A1 c,BALP,OC,β-CTX,PTH,PINP,SUA,VFA,and SFA were used as independent variables for multiple linear regression analysis.In male T2 DM patients,age and SUA were independently correlated with lumbar bone density.VFA was independently correlated with total hip bone density(all P < 0.05).In female patients,age and VFA were independently associated with lumbar bone density,and age was independently associated with hip bone density(both P < 0.05).Conclusion:1.In hospitalized T2 DM patients over 50 years old,bone formation decreased with the increase of abdominal visceral fat and subcutaneous fat area,which may lead to bone loss.Men also had higher bone mineral density than postmenopausal women.2.In male T2 DM patients,advanced age and high uric acid were the risk factors for lumbar bone density,while high visceral fat area was the risk factor for hip bone density.3.In female T2 DM patients,advanced age was a risk factor for lumbar vertebra bone density and hip bone density,while high visceral fat area was a risk factor for lumbar vertebra bone density.