A Cross-sectional Study: Association Between sarcopenia and Osteoporosis in Type 2 Diabetes Mellitus Patients With a High Glycated Hemoglobin Level

Abstract Background: Sarcopenia and osteoporosisare commonly observed in individuals with type 2 diabetes mellitus (T2DM).Thus, this study investigated the association between sarcopenia and osteoporosis in T2DM patients with a highglycated hemoglobin (HbA1c)level. Methods: This study recruited 98 Chinese patients with T2DM who were aged ≥ 50 years, and their body compositions were evaluated using dual-energy X-ray absorptiometry. Moreover, the fFasting blood glucose, HbA1c, B collagen-specific sequences (B-CTX), osteocalcin(OC), propeptide of type 1 procollagen(P1NP), 25-hydroxy vitamin Dlevels were evaluated.Sarcopenia was defined as skeletal muscle mass index (SMI) <7.0 kg/m 2 for men and < 5.4 kg/m 2 for women. Results: There were 42 men and 56 women, with an average age of 65.86 ± 8.32 years and HbA1c level of 8.59% ± 1.87%. The prevalence rates ofsarcopenia, osteopenia, and osteoporosis were48.0%, 37.8%, and 33.6%, respectively.Moreover, the prevalence of osteoporosis was significantly higher in women than in men (50% vs. 11.9%, P = 0.000).The prevalence of sarcopenia was significantly higher in patients with HbA1c levels> 9.0% than in those with HbA1c levels < 9.0% (62.2% vs. 39.3%, P = 0.037). However, the prevalence of osteopenia and osteoporosis in patients with HbA1c levels > 9.0% differed from those with HbA1c levels < 9.0%(29.5% vs.51.4% for osteopenia, 32.8% vs.35.1% for osteoporosis; P = 0.022). The height and weight of the osteoporosis group significantly decreased compared with those of the normal bone mineral density (BMD), whereas the serum BCTX, OC, and PINP levels significantly increased.The SMI, trunk muscles, skeletal muscle parameters, lumbar spine bone mineral content (BMC), lumbar spine BMD, femoral BMC, and femoral BMD decreased significantly in T2DM patients with osteoporosis.Sarcopeniawas associated with a higher height (odds ratio [OR] = 1.524, 95% confidence interval [CI] = 1.196-1.698, P = 0.000), lower body weight (OR = 0.735, 95% CI = 0.640-0.844, P = 0.000), and higher body fat content (OR = 1.211, 95% CI = 1.046-1.402, P = 0.011). Meanwhile, osteoporosis was correlated to a lower SMI (OR = 0.178, 95% CI = 0.044-0.817, P = 0.015). Conclusions: Ahigh HbA1c level was associated with a higher prevalence of sarcopenia and osteoporosis in T2DM patients, and low muscle masswas considered a risk factor for osteoporosis inthis group of patients.