ArticleFrontiers in molecular biosciences2026
Predictive value of insulin resistance related indicators for osteoporosis risk in patients with type 2 diabetes mellitus: a real-world study.
Article in Frontiers in molecular biosciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Insulin resistance (IR) contributes to osteoporosis (OP) by impairing bone microarchitecture, posing significant fragility-fracture risk in patients with type 2 diabetes mellitus (T2DM). The triglyceride-glucose (TyG) index and its anthropometry-adjusted derivatives (TyG-body mass index [BMI], TyG-waist circumference [WC]) are simple IR surrogates that may aid OP risk stratification. This study evaluated TyG, TyG-BMI and TyG-WC as independent predictors for OP in T2DM. Methods: In a retrospective cohort of 568 patients with T2DM (36 OP cases), baseline clinical, laboratory (HbA1c, haemoglobin [HGB], high-density lipoprotein cholesterol [HDL], serum calcium [Ca]) and bone-metabolism (procollagen type 1 N-terminal propeptide [P1NP], osteocalcin [OC], bone-specific alkaline phosphatase [BAP]) data were analyzed. Candidate covariates were selected by least absolute shrinkage and selection operator (LASSO) regression with variance inflation factors (VIF) screening. Because the events-per-variable ratio was low (≈4), three Firth's penalised-likelihood logistic regression models were fitted for TyG, TyG-BMI or TyG-WC as the primary analysis. Discrimination was assessed by the area under the receiver-operating-characteristic curve (AUC) with 95% confidence intervals (CIs) and pairwise DeLong tests. Results: All three indices were significantly higher in OP than non-OP patients (all P < 0.001). After Firth-penalised adjustment, only remained independently associated with TyG-WC (OR 1.004; 95% CI 1.001-1.008; P = 0.013); TyG (P = 0.075) and TyG-BMI (P = 0.105) showed positive but non-significant associations. Higher HbA1c, OC and BAP increased the odds of OP, while male sex and higher HGB were protective. Discrimination was high and similar across models (apparent AUCs: 0.896 [TyG], 0.887 [TyG-BMI] and 0.901 [TyG-WC], with no DeLong-significant difference between indices. Conclusion: Among the three IR surrogates, only TyG-WC was independently associations with OP in T2DM, although overall discrimination was comparable across indices. TyG-WC may serve as low-cost adjuncts for identifying diabetic patients at elevated OP risk, pending prospective external validation.
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