Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Feb 15, 2025; 16(2): 98085
Published online Feb 15, 2025. doi: 10.4239/wjd.v16.i2.98085
Association between body mass index and lumbar spine volumetric bone mineral density in diabetic and non-diabetic patients
Fang Lv, Xiao-Ling Cai, Xiu-Ying Zhang, Xiang-Hai Zhou, Xue-Yao Han, Yu-Feng Li, Li-Nong Ji
Fang Lv, Xiao-Ling Cai, Xiu-Ying Zhang, Xiang-Hai Zhou, Xue-Yao Han, Li-Nong Ji, Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing 100044, China
Yu-Feng Li, Department of Endocrinology, Beijing Friendship Hospital Pinggu Campus, Beijing 101200, China
Co-first authors: Fang Lv and Xiao-Ling Cai.
Co-corresponding authors: Yu-Feng Li and Li-Nong Ji.
Author contributions: Cai XL, Li YF, and Ji LN conceptualized and designed the research; Lv F, Cai XL, Li YF, Zhang XY, Zhou XH, and Han XY screened the patients and acquired the clinical data; Cai XL, Li YF, Zhang XY, Zhou XH, and Han XY collected the blood specimens and performed laboratory analysis; Lv F and Cai XL performed data analysis; Lv F, Cai XL, and Ji LN wrote the paper; all the authors have read and approved the final manuscript. Lv F performed data analysis and prepared the first draft of the manuscript. Cai XL was responsible for patient screening and enrollment, and collection of clinical data and blood specimens. Lv F and Cai XL have contributed equally to this work as co-first authors. Both Li YF and Ji LN have played important and indispensable roles in the experimental design, data interpretation, and manuscript preparation as co-corresponding authors. Ji LN conceptualized, designed, and supervised the whole process of the project. Li YF was instrumental and responsible for data re-analysis and re-interpretation, figure plotting, and comprehensive literature search. This collaboration between Li YF and Ji LN is crucial for the publication of this manuscript and other manuscripts still in preparation.
Supported by National Natural Science Foundation of China, No. 81970698 and No. 81900805; and Peking University People's Hospital Research and Development Funds, No. Project RS2022-03.
Institutional review board statement: The study was reviewed and approved by the ethics committee of Peking University People’s Hospital (Approval No. 2021PHB441-001).
Informed consent statement: The data were anonymous and informed consent was waived by the approving Institutional Review Board because of the nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data relevant to the study are available from the corresponding author at jiln@bjmu.edu.cn upon reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Nong Ji, MD, Professor, Department of Endocrinology and Metabolism, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China. jiln@bjmu.edu.cn
Received: June 17, 2024
Revised: October 6, 2024
Accepted: November 21, 2024
Published online: February 15, 2025
Processing time: 195 Days and 18.9 Hours
Abstract
BACKGROUND

The association between body mass index (BMI) and bone mineral density (BMD) has shown inconsistent results, varying by sex and skeletal site. Despite normal or elevated bone mass, individuals with type 2 diabetes have an increased risk of hip and vertebral fractures.

AIM

To assess lumbar spine trabecular volumetric BMD (vBMD) across different BMI categories in individuals with and without diabetes.

METHODS

This cross-sectional study included 966 men over 50 years old and 1001 postmenopausal women from the Pinggu Metabolic Disease Study. The vBMD of lumbar vertebrae 2 through 4 was measured using quantitative computed tomography. Total adipose tissue, subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and lumbar skeletal muscle area were also quantified.

RESULTS

In men with obesity (P = 0.038) and overweight (P = 0.032), vBMD was significantly higher in the diabetes group compared to non-diabetic men. After adjusting for age and sex, no significant saturation effect between BMI and BMD was found in participants with diabetes or in women without diabetes. However, a BMI threshold of 22.33 kg/m² indicated a saturation point for vBMD in non-diabetic men. Independent predictors of vBMD in men included age (r = -0.387, P < 0.001), BMI (r = 0.130, P = 0.004), and VAT (r = -0.145, P = 0.001). For women, significant predictors were age (r = -0.594, P < 0.001), BMI (r = 0.157, P = 0.004), VAT (r = -0.112, P = 0.001), and SAT (r = -0.068, P = 0.035).

CONCLUSION

The relationship between BMI and trabecular vBMD differs in individuals with and without diabetes. Overweight and obese men with diabetes exhibit higher vBMD.

Keywords: Obesity and overweight; Body mass index; Diabetes; Lumbar spine volumetric bone mineral density; Quantitative computed tomography

Core Tip: The association between body mass index (BMI) and bone mineral density (BMD) has shown contradictory findings, which depends on sex and skeletal sites. By using data from Pinggu Metabolic Disease Study, we examined the association between BMI, body composition, and lumbar spine trabecular volumetric BMD (vBMD) in patients with and without diabetes. We found that men with obesity and overweight aged over 50 years with diabetes had favorable trabecular vBMD than participants without diabetes. The trabecular vBMD had different trend patterns with the increase of BMI in participants with and without diabetes. There was a saturation effect value between BMI (22.33 kg/m2) and vBMD in men without diabetes.