Associations of Obesity Indices with Bone Mineral Densities and Risk of Osteoporosis Stratified Across Diabetic Vascular Disease in T2DM Patients

Figures & data

Table 1 Demographic and Clinical Characteristics of Subjects Stratified by Osteoporosis in 250 T2DM Patients

Variables	Osteoporosis
	Total	No	Yes	P value
Demographics
N (%)	250 (100.0%)	200 (80.0%)	50 (20.0%)
Woman Sex (n, %)	101 (40.4%)	67 (33.5%)	34 (68.0%)	<0.001
Age (years)	57.8±11.7	56.5±12.0	62.8±9.1	<0.001
Ever smoking (n, %)	91 (36.4%)	80 (40.0%)	11 (22.0%)	0.018
Ever drinking (n, %)	64 (25.6%)	54 (27.0%)	10 (20.0%)	0.310
Clinical characteristics
Weight (kg)	67.7±12.7	69.8±12.2	59.1±11.1	<0.001
Height (cm)	164.9±8.7	166.3±8.2	159.3±8.2	<0.001
BMI (kg/m^2)	24.8±3.5	25.2±3.5	23.2±3.3	<0.001
BMI category (kg/m^2, n (%))				0.005
Normal weight or below (<23.0)	84 (33.6%)	58 (29.0%)	26 (52.0%)
Overweight (23.0–24.9)	53 (21.2%)	43 (21.5%)	10 (20.0%)
Obesity I & II (≥25.0)	113 (45.2%)	99 (49.5%)	14 (28.0%)
Waist (cm)	88.6±9.6	89.6±9.5	84.5±9.2	0.001
Waist hip ratio	0.94±0.06	0.95±0.06	0.92±0.06	0.017
Systolic blood pressure (mmHg)	131.3±16.9	131.1±16.9	132.0±16.7	0.741
Diastolic blood pressure (mmHg)	82.1±9.9	82.2±9.9	81.7±10.1	0.756
Triglyceride (mmol/L)	1.99±2.12	2.09±2.30	1.60±1.07	0.148
Total cholesterol (mmol/L)	4.57±1.55	4.57±1.12	4.58±2.66	0.943
HDL-cholesterol (mmol/L)	1.12±0.32	1.10±0.28	1.23±0.44	0.011
LDL-cholesterol (mmol/L)	2.55±1.00	2.60±1.00	2.37±0.98	0.135
Fasting plasma glucose (mmol/L)	8.36±3.08	8.51±3.09	7.77±2.99	0.127
HbA1c (%)	9.14±2.31	9.20±2.36	8.89±2.09	0.393
HOMA-IR (*10-6mol*IU*L^−2)	5.26±1.93	5.19±2.06	5.52±1.23	0.915
History of T2DM (years)	7.85±6.79	7.42±6.79	9.59±8.57	0.057
Blood uric acid (µmol/L)	352.2±97.5	359.6±97.2	322.8±94.1	0.017
Diabetic vascular complications
Diabetic retinopathy (n, %)	74 (29.6%)	58 (29.0%)	16 (32.0%)	0.678
Diabetic kidney disease (n, %)	41 (16.4%)	34 (17.0%)	7 (14.0%)	0.608
Diabetic peripheral neuropathy (n, %)	36 (14.4%)	28 (14.0%)	8 (16.0%)	0.719
Diabetic peripheral arterial disease (n, %)	172 (68.8%)	134 (67.0%)	38 (76.0%)	0.219
Any of diabetic vascular complications (n, %)	202 (80.8%)	160 (80.0%)	42 (84.0%)	0.521
T-score of bone mineral density (BMD)
Lumbar vertebra	−1.17±1.31	−0.75±1.04	−2.83±0.90	<0.001
Femoral neck	−1.32±1.00	−1.02±0.82	−2.52±0.70	<0.001
Hip joint	−0.91±0.95	−0.62±0.76	−2.10±0.64	<0.001
Minimum T-score	−1.67±1.03	−1.29±0.73	−3.17±0.62	<0.001

Notes: All percentages are column percentage; except for percentages, all values are mean ± s.d.

Abbreviations: BMD, bone mineral density; BMI, body mass index; HDL, high-density lipoprotein; HOMA-IR, homeostasis model assessment - insulin resistance; LDL, low-density lipoprotein cholesterol; T2DM, type 2 diabetes mellitus.

Table 2 Multivariable Linear Regression for Minimum T-Score of BMD and Logistic Regression for Osteoporosis in 250 T2DM Subjects

Variables	Minimum T-Score of BMD			Osteoporosis
	Standardized Beta	Standard Error (SE)	P-value	OR	95% CI	P-value
Sex (Postmenopausal women vs men)	−0.416	0.167	0.013	5.165	1.762–15.138	0.003
Age (years)	−0.156	0.006	0.034	1.043	0.999–1.090	0.058
Ever smoking	−0.006	0.154	0.938	0.973	0.321–2.950	0.962
Ever drinking	0.011	0.158	0.868	3.789	1.087–13.214	0.037
Weight (kg)	0.332	0.007	<0.001	0.938	0.894–0.984	0.008
Height (cm)	0.124	0.012	0.229	0.962	0.895–1.035	0.297
BMI (kg/m^2)^†	0.281	0.066	<0.001	0.547	0.357–0.840	0.006
BMI category (kg/m^2)
Normal weight or below (<23.0)	…			1.000
Overweight (23.0–24.9)	0.126	0.175	0.071	0.874	0.331–2.310	0.786
Obesity I & II (≥25.0)	0.269	0.149	<0.001	0.350	0.151–0.812	0.014
Trend test			<0.001			0.014
Waist (cm)	0.204	0.007	0.003	0.954	0.912–0.998	0.040
Waist hip ratio	0.023	1.129	0.741	0.045	0.001–27.784	0.344
Systolic blood pressure (mmHg)	0.038	0.005	0.624	0.980	0.953–1.008	0.165
Diastolic blood pressure (mmHg)	−0.045	0.008	0.556	1.046	0.995–1.099	0.076
Triglyceride (mmol/L)	−0.078	0.034	0.266	0.846	0.532–1.346	0.481
Total cholesterol (mmol/L)	−0.087	0.055	0.299	1.157	0.810–1.651	0.423
HDL-cholesterol (mmol/L)	−0.024	0.217	0.729	0.931	0.264–3.276	0.911
LDL-cholesterol (mmol/L)	0.170	0.082	0.032	0.624	0.373–1.044	0.072
Fasting plasma glucose (mmol/L)	0.137	0.021	0.027	0.941	0.824–1.075	0.371
HbA1c (%)	0.030	0.030	0.652	0.956	0.805–1.135	0.609
HOMA-IR (*10-6mol*IU*L^−2)	−0.001	0.003	0.765	0.999	0.982–1.017	0.912
History of T2DM (years)	−0.014	0.009	0.160	1.019	0.964–1.078	0.495
Blood uric acid (µmol/L)	0.088	0.001	0.172	0.997	0.993–1.002	0.217
Diabetic vascular complications
Diabetic retinopathy	0.138	0.136	0.818	0.947	0.439–2.043	0.890
Diabetic kidney disease	0.038	0.172	0.542	0.826	0.294–2.323	0.717
Diabetic peripheral neuropathy	0.014	0.177	0.820	0.922	0.355–2.391	0.867
Diabetic peripheral arterial disease (n, %)	−0.069	0.145	0.284	1.630	0.675–3.935	0.277
Any of diabetic vascular complications	−0.016	0.167	0.798	1.080	0.372–3.137	0.887

Notes: ^†BMI was impressed by per SD increase of BMI.

Abbreviations: BMD, bone mineral density; BMI, body mass index; CI, confidence interval; HDL, high-density lipoprotein; HOMA-IR, homeostasis model assessment - insulin resistance; LDL, low-density lipoprotein cholesterol; OR, odds ratio; T2DM, type 2 diabetes mellitus.

Table 3 Multivariable Linear Regression for Minimum T-Score of BMD and Logistic Regression for Osteoporosis Stratified by Any of Diabetic Vascular Diseases in 250 T2DM Subjects

Variables	Minimum T-Score of BMD			Osteoporosis
	Standardized Beta	Standard Error (SE)	P-value	OR	95% CI	P-value
No any of diabetic vascular disease
Weight (kg)	0.076	0.017	0.763
Height (cm)	0.508	0.030	0.076
BMI (kg/m^2)^†	0.186	0.184	0.322
BMI category (kg/m^2)
Normal weight or below (<23.0)
Overweight (23.0–24.9)	0.298	0.475	0.150
Obesity I & II (≥25.0)	0.327	0.452	0.146
Trend test			0.182
Waist (cm)	0.437	0.021	0.052
Waist hip ratio	0.447	3.388	0.051
Any of diabetic vascular diseases
Weight (kg)	0.362	0.008	<0.001	0.937	0.889–0.988	0.015*
Height (cm)	0.052	0.014	0.652	0.978	0.902–1.061	0.596
BMI (kg/m^2)^†	0.299	0.073	<0.001	0.546	0.341–0.877	0.012*
BMI category (kg/m^2)
Normal weight or below (<23.0)				1.000
Overweight (23.0–24.9)	0.108	0.199	0.166	0.681	0.224–2.074	0.499
Obesity I & II (≥25.0)	0.272	0.162	0.001	0.349	0.139–0.878	0.025*
Trend test			0.001			0.025*
Waist (cm)	0.177	0.008	0.019	0.959	0.913–1.006	0.087
Waist hip ratio	−0.029	1.239	0.695	0.127	0.001–129.751	0.560

Notes: ^†BMI was impressed by per SD increase of BMI. Both linear regression and logistic regression were adjusted for age, sex, ever smoking and drinking, systolic and diastolic BP, triglyceride, total cholesterol, HDL- and LDL-cholesterol, fasting plasma glucose, history of T2DM, blood uric acid and any of diabetic cardiovascular complications.

Abbreviations: BMD, bone mineral density; BMI, body mass index; CI, confidence interval; OR, odds ratio.