Association Between Coronary Artery Calcium Score and Bone Mineral Density in Type 2 Diabetes Mellitus with Different Visceral Fat Area

Figures & data

Figure 1 Flow diagram of the enrollment of study subjects.

Abbreviations: BMD, bone mineral density; VFA, visceral fat area.

Figure 2 Identification of coronary artery calcifications (red arrows) in patients with type 2 diabetes. The coronary calcium score of left was 64 (with non-visceral obesity) while the right was 302 (with visceral obesity).

Table 1 Clinical and Biochemical Features

	All	VFA<100cm^2	VFA≥100 cm^2	p
Number (n)	479	278	201
Age (year)	60.4±9.8	60.0±10.3	61.0±9.2	0.527
Males (n (%))	266(55.8)	146(52.7)	120(60.3)	0.258
Diabetes duration(year)	10.0±7.6	10.3±7.7	9.6±7.4	0.641
Hight(cm)	167.4±9.1	166.7±9.4	168.2±8.5	0.255
Weight (kg)	68.8±11.2	68.5±11.9	69.1±10.3	0.850
BMI (kg/m^2)	24.6±4.2	24.4±3.6	24.7±4.7	0.832
SBP (mmHg)	139.4±19.5	140±19.7	138.7±19.3	0.795
DBP (mmHg)	80.4±10.9	80±10.5	80.9±11.5	0.703
FPG (mmol/L)	8.3±3.4	8.1±2.9	8.5±3.9	0.399
2hPG (mmol/L)	16.2±6.3	15.5±5.8	17±6.8	0.083
HbA1c (%)	8.0±2.0	7.9±1.8	8.2±2.1	0.296
HDL (mmol/L)	1.0±0.2	1.0±0.2	1.1±0.2	0.585
LDL (mmol/L)	2.8±0.9	2.8±0.9	2.9±1.0	0.549
TC (mmol/L)	4.2±1.2	4.1±1.1	4.3±1.3	0.332
TG (mmol/L)	2.0±1.7	1.8±1.2	2.1±2.0	0.171
Ca (mmol/L)	2.2±0.2	2.1±0.2	2.3±0.1	0.621
P (mmol/L)	1.2±0.2	1.2±0.1	1.2±0.2	0.865
B-ALP (U/L)	75.1±26.7	74.2±28.1	76±25.1	0.823
25(OH)D (nmol/L)	12.9±5.6	12.9±5.5	13.0±5.7	0.981
VFA (cm^2)	85.1±34.4	70.6±21.3	131.1±26.6	<0.001**
CACs	169.7±170.1	139.3±141.8	212.1±195.9	<0.001**
Bone mineral density
Total hip (g/cm^2)	0.999±0.188	1.021±0.184	0.968±0.19	0.010*
Femoral neck (g/cm^2)	0.908±0.2	0.922±0.205	0.888±0.193	0.191
Lumbar spine (g/cm^2)	1.087±0.196	1.091±0.192	1.082±0.2	0.877

Note: *p < 0.05; **p < 0.001.

Abbreviations: BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; FPG, fasting plasma glucose; 2hPG, 2hour plasma glucose; HDL, high density lipoprotein; LDL, low density lipoprotein; TC, total cholesterol; TG, triglyceride; B-ALP, bone-alkaline phosphatase; VFA, visceral fat area; CACs, coronary artery calcium score.

Figure 3 Coronary artery calcium score distribution difference between VFA<100cm² and VFA≥100cm².

Figure 4 Bone mineral density distribution difference between VFA<100cm² and VFA≥100cm² in 3 locations.

Table 2 Comparation of CACs in T2DM Patients of Normal, Osteopenia and Osteoporosis

	Normal	Osteopenia	Osteoporosis	p
All
Total(n)	116.3±104.2(149)	177.5±150.8(171)	183.4±171.8(159)	0.03*
Males(n)	120.4±126.8(84)	158.5±154.3(93)	227.3±202.5(78)	<0.001**
Females(n)	122.6±137.9(65)	142.5±156.3(78)	272.4±222.1(81)	<0.001**
VFA≤100 cm^2
Total(n)	116.8±104.9(81)	164.9±167.7(103)	149.6±148.2(93)	0.349
Males(n)	135.4±150.3(47)	131.9±139.7(60)	150.9±137.3(39)	0.621
Females(n)	148.8±175.9(34)	108.3±111.2(43)	152.5±122.6(54)	0.194
VFA>100cm^2
Total(n)	115.2±105.9(68)	193.1±127.6(68)	244.1±200.0(66)	0.029*
Males (n)	101.6±86.8(37)	198.7±167.3(33)	331.6±231.9(39)	<0.001**
Females(n)	96.8±79.8(31)	204.7±203.0(35)	392.2±235.4(27)	<0.001**

Note: *p < 0.05; **p < 0.001.

Figure 5 Coronary artery calcium score distribution difference among normal, osteopenia and osteoporosis in visceral fat area <100cm² and visceral fat area ≥100cm² group.

Table 3 Correlation Between CACs (Log x) and BMD by Adjusted Regression

	Total Hip BMD			Femoral Neck BMD			Lumbar Spine BMD
	β	95% CI	p	β	95% CI	p	β	95% CI	p
All
Model 0	−0.112	(−0.149, −0.076)	<0.001**	−0.124	(−0.164, −0.085)	<0.001**	−0.120	(−0.158, −0.081)	<0.001**
Model 1	−0.109	(−0.148, −0.070)	<0.001**	−0.124	(−0.165, −0.083)	<0.001**	−0.120	(−0.160, −0.080)	<0.001**
Model 2	−0.038	(−0.086, 0.010)	0.117	−0.070	(−0.123, −0.016)	0.011*	−0.065	(−0.115, −0.015)	0.012*
Model 3	−0.04	(−0.099, 0.020)	0.190	−0.060	(−0.126, 0.006)	0.075	−0.047	(−0.109, 0.015)	0.139
VFA<100 cm^2
Model 0	0.006	(−0.049, 0.061)	0.828	−0.019	(−0.08, 0.043)	0.551	0.001	(−0.058, 0.058)	0.999
Model 1	0.021	(−0.037, 0.078)	0.480	−0.017	(−0.083, 0.049)	0.609	−0.002	(−0.063, 0.058)	0.940
Model 2	0.020	(−0.041, 0.08)	0.525	−0.020	(−0.088, 0.049)	0.569	−0.008	(−0.071, 0.055)	0.794
Model 3	0.007	(−0.074, 0.089)	0.861	−0.025	(−0.116, 0.067)	0.593	0.001	(−0.083, 0.085)	0.983
VFA≥100 cm^2
Model 0	−0.218	(−0.263, −0.172)	<0.001**	−0.226	(−0.272, −0.18)	<0.001**	−0.246	(−0.293, −0.200)	<0.001**
Model 1	−0.210	(−0.260, −0.161)	<0.001**	−0.216	(−0.265, −0.166)	<0.001**	−0.236	(−0.286, −0.185)	<0.001**
Model 2	−0.088	(−0.143, −0.033)	0.002*	−0.084	(−0.147, −0.021)	0.01*	−0.063	(−0.094, −0.032)	<0.001**
Model 3	−0.087	(−0.152, −0.022)	0.010*	−0.070	(−0.150, 0.011)	0.09	−0.052	(−0.087, −0.017)	0.005*

Note: *p < 0.05; **p < 0.001. Model 0: Unadjusted; Model 1: Adjusted for age, sex, diabetes duration; Model 2: Adjusted for the covariates in Model 1+BMI, SBP, DBP, HbA1c, VFA; Model 3: Adjusted for the covariates in Model 2+HDL, LDL, TG, TC, Ca, ALP, 25(OH)D.

Figure 6 Standardized regression coefficients are shown for correlation between CACs and BMD by adjusted regression analyses in all patients, visceral fat area <100cm² and visceral fat area ≥100cm².

Notes: Model 0: Unadjusted; Model 1: Adjusted for age, sex, diabetes duration; Model 2: Adjusted for the covariates in Model 1+BMI, SBP, DBP, HbA1c, VFA; Model 3: Adjusted for the covariates in Model 2+HDL, LDL, TG, TC, Ca, ALP, 25(OH)D.

Figure 7 ROC curve analysis of CACs screening osteoporosis.