Hui-Lin Lu, Fang Yu, Hai-Feng Zhou, Ping Hu, Sheng-Lian Gan
BACKGROUND The prevalence of osteoporosis (OP) among individuals with type 2 diabetes mellitus (T2DM) has increased significantly, markedly elevating the risk of fragility fractures. AIM To investigate the clinical significance of bone metabolic markers (BMMs) in patients with T2DM with comorbid OP and identified associated risk determinants. METHODS A total of 215 patients with T2DM, with (OP group) or without (non-OP group) OP, who attended The First People’s Hospital of Changde City between May 2021 and July 2025 were enrolled. The levels of BMMs were compared between the OP and non-OP groups. Using dual-energy X-ray absorptiometry as the gold standard for OP diagnosis, the correlations between BMMs and OP comorbidity in T2DM were evaluated. The risk determinants were subsequently identified. RESULTS Significant intergroup differences were observed in age and glycosylated hemoglobin (P < 0.05), whereas alkaline phosphatase, high-density lipoprotein cholesterol, 1,25-dihydroxyvitamin D3, blood phosphorus, blood calcium, total cholesterol, triglyceride, or low-density lipoprotein cholesterol levels did not differ significantly (P > 0.05). Sex and smoking/drinking history were also comparable between groups (P > 0.05). Parathyroid hormone (PTH) and β-C-terminal telopeptide of type I collagen levels were significantly higher in T2DM patients with OP than in those without OP (P < 0.05). The two groups showed no significant differences in DM duration, comorbid diseases, peripheral neuropathy, and fasting blood glucose (P > 0.05). Age and PTH emerged as independent risk determinants for OP comorbidity in T2DM (P < 0.05). CONCLUSION Elevated PTH levels in T2DM patients with comorbid OP suggest that PTH provides valuable guidance for OP diagnosis in this population. Age and PTH were independently associated with OP in T2DM.