The Correlation Between Creatinine-cystatin C Ratio And Bone Mineral Density In Patients With Type 2 Diabetes Mellitus

Objective:Osteoporosis or decreased bone mineral density is a common health problem in elderly patients with type 2 diabetes,which may related to the patient’s quality of muscle mass and muscle damage.Cre/Cys C has become an effective predictor of muscle health.This study explored the correlation between Cre/Cys C and bone mineral density in elderly patients with type 2 diabetes mellitus,and analyzed the predictive ability of this index to osteopenia and osteoporosis.to provide a basis for early detection and diagnosis and treatment of osteopenia and osteoporosis.Methods:This cross-sectional study included 472 type 2 diabetic patients over 50 years old who were hospitalized in the Department of Endocrinology,Affiliated Hospital of Jining Medical College from June2021 to April 2022,and collected a number of clinical indicators,including physical measurement,blood biochemistry and bone mineral density.Pearson correlation test was used to analyze the correlation between each index and bone mineral density in different parts,and the correlation scatter diagram was drawn.The independent correlation factors of bone mineral density in lumbar spine,femoral neck and total hip were determined by multiple linear regression analysis.According to whether it was osteopenia and osteoporosis,the variable differences between groups were analyzed,and the independent predictors of osteopenia and osteoporosis were identified by logistic regression.By drawing the subjects’ working characteristic curve,the predictive ability of these factors was evaluated and the best predictive critical value was obtained.Results:(1)Correlation analysis of lumbar spine BMD: body mass index(r=0.235,P<0.001),creatinine(r=0.123,P=0.008),Cre/Cys C(r=0.171,P<0.001),uric acid(r=0.142,P=0.002),blood phosphorus(r=0.141,P=0.002),IGF-1(r=0.136,P=0.004)was positively correlated with lumbar spine BMD,age(r=-0.215,P<0.001),follicle stimulating hormone(r=-0.193,P<0.001)was negatively correlated with lumbar spine BMD.In multiple linear regression analysis,follicle stimulating hormone(β=-0.234,P<0.041),Cre/Cys C(β=0.149,P=0.002),body mass index(β=0.170、P<0.001),age(β=-0.129,P=0.006)were independent predictors of lumbar spine BMD.(2)Correlation analysis of femoral neck BMD:Age(r=-0.318,P<0.001),disease duration(r=-0.119,P=0.010),glycosylated hemoglobin(r=-0.105,P=0.024),cystatin C(r=-0.098,P=0.034),follicle stimulating hormone(r=-0.201,P<0.001)was negatively correlated with bone density of femoral neck.Body mass index(r=0.340、P<0.001),Cre/Cys C(r=0.183,P<0.001),uric acid(r=0.128,P=0.006),blood phosphorus(r=0.209,P<0.001),IGF-1(r=0.166,P<0.001)was positively correlated with BMD of femoral neck.In multiple linear regression analysis,age(β=-0.198,P<0.001),sex(β=0.260,P<0.001),body mass index(β=0.259,P<0.001),follicle stimulating hormone(β=-0.119,P=0.041),Cre/Cys C(β=0.120,P=0.007),phosphorus(β=0.097,P=0.021)were independent predictors of BMD of femoral neck.(3)Correlation analysis of total hip BMD:Age(r=-0.296,P<0.001),Cystatin C(r=-0.120,P=0.010),fasting blood-glucose(r=-0.096,P=0.039),follicle stimulating hormone(r=-0.198,P<0.001)were negatively correlated with hip BMD.Cre/Cys C(r=0.185,P<0.001),uric acid(r=0.181,P<0.001),triglyceride(r=0.095,P=0.039),phosphorus(r=0.204,P<0.001),IGF-1(r=0.161,P=0.001)was positively correlated with hip BMD.In multivariate linear regression analysis,age(β=-0.193,P<0.001),sex(β=0.226,P<0.001),body mass index(β=0.318,P<0.001),follicle stimulating hormone(β=-0.132,P=0.023),Cre/Cys C(β=0.122,P=0.006),fasting blood-glucose(β=-0.092,P=0.021),phosphorus(β=0.087,P=0.035)were independent predictors of total hip BMD.(4)Analysis of independent related factors between osteopenia and osteoporosis: the older the patients,the lower the body mass index,and the lower the Cre/Cys C,the more likely to develop osteopenia and osteoporosis.In addition,patients with osteopenia and osteoporosis had lower levels of serum creatinine,uric acid,indirect bilirubin,serum phosphorus and insulin-like growth factor-1,and higher levels of glycosylated hemoglobin.Logistic regression showed that age,BMI,Hb A1 c and Cre/Cys C were independent predictors of osteopenia,while age,BMI and Cre/Cys C were independent predictors of osteoporosis.(5)Analysis of predictive ability of Cre/Cys C for osteopenia and osteoporosis: Cre/Cys C as a predictor of osteopenia and osteoporosis,the area under the curve was 0.656(P < 0.001)and 0.697(P < 0.001).The critical points were 6.39(sensitivity 62.3%,specificity 66%)and 5.87(sensitivity 67.1%,specificity 64.3%).Conclusion:This study proved for the first time that Cre/Cys C was independently positively correlated with bone mineral density in patients with type 2 diabetes mellitus,and was an independent predictor of osteopenia and osteoporosis.The Cre/Cys C is relatively good predictive for the osteopenia and osteoporosis in type 2 diabetes patients,and can be used as a simple indicator for early screening.