Correlation of VSR with osteoporosis and fractures in patients with type 2 diabetes mellitus

Objective  To investigate the relationship of the visceral fat area to skeletal muscle mass ratio (VSR) with osteoporosis (OP) and fracture risk in patients with type 2 diabetes mellitus (T2DM).

Methods  A total of 549 patients with T2DM who were hospitalized in the Department of Endocrinology, the First Hospital of Lanzhou University, from January 2022 to March 2023 were included in this study. Lumbar spine and hip bone mineral density (BMD) were measured by dual-energy X-ray absorptiometry (DXA). Visceral fat area (VFA) and appendicular skeletal muscle mass (ASM) were measured by bioelectrical impedance analysis, and VSR was calculated. According to the diagnostic criteria for OP, the patients were divided into the normal bone mass group, osteopenia group and OP group. According to VSR quartiles, the patients were divided into Q1 to Q4 groups. BMD, the prevalence of OP and the risk of vertebral fracture were compared among the four groups. Multivariable Logistic regression analysis was used to examine the relationship of VSR with OP and fracture risk.

Results  VSR was higher in the OP group than those in the normal bone mass group and osteopenia group (both P ＜ 0.05). Differences in BMD and VSR among the young, middle-aged and elderly groups were statistically significant (all P ＜ 0.05). With increasing VSR, BMD showed an inverted U-shaped trend, reaching the highest level in the Q2 group and the lowest level in the Q4 group. A high VSR level was correlated with a higher prevalence of lumbar OP, and the prevalence of OP in women was higher than that in men across all groups (all P ＜ 0.05). Multivariable Logistic regression analysis showed that VSR was not correlated with OP or fracture risk in the overall population (P ＞ 0.05). In the middle-aged group, VSR was positively correlated with the risk of OP (all P ＜ 0.05).

Conclusion  In middle-aged patients with T2DM, an increased VSR is correlated with the risk of OP and may serve as an early warning indicator of bone degeneration and metabolic imbalance in this specific population.