Relationship of Bone Status with Serum Uric Acid and Bilirubin in Men with Type 2 Diabetes: A Cross-Sectional Study

Association between serum uric acid levels and bone mineral density in Chinese and American: a cross-sectional study

Despite extensive studies conducted on the relationship between serum uric acid (UA) and bone mineral density (BMD), their association remains controversial. In this study, we investigated whether UA levels are independently associated with BMD in Chinese and American populations to elucidate their association. Herein, the data of 12,344 individuals (age > 20 years) from the National Health and Nutrition Examination Survey (2005-2018) and those of 768 individuals from the inpatient medical records and physical examination center systems of the Tertiary Class A Hospital (2021-2023) from China were included. The association between UA and BMD was analyzed by employing multivariate regression models with covariate adjustments. In addition, population description, stratified analysis, single-factor analysis, smooth-curve fitting, and threshold and saturation effect analyses were performed. After covariate adjustments, UA exhibited an association with BMD of the femur (β = 0.008, 95% confidence interval [CI] 0.001-0.015, P = 0.02), femoral neck (β = 0.011, 95% CI 0.004-0.018, P = 0.002), and lumbar spine (β = 0.014, 95% CI 0.06-0.022, P < 0.001) in American subjects. Similarly, UA exhibited association with BMD of the femur (β = 0.079, 95% CI 0.042-0.117, P < 0.001), femoral neck (β = 0.171, 95% CI 0.121-0.22, P < 0.001), and lumbar spine (β = 0.052, 95% CI 0.007-0.097, P = 0.024) in Chinese subjects. Notably, the relationship between UA levels and BMD was nonlinear. The saturated utility values for determining the UA level with BMD of the femur and femoral neck using a two-stage linear regression model were 429.9 and 468 μmol/L, respectively, in the Chinese population. In the American population, the saturated utility values of UA level with BMD of the femur, femoral neck, and lumbar spine were 410.4, 410.4, and 452 μmol/L, respectively. Altogether, the present findings suggested a positive association between the UA levels and overall BMD in adults, implying that maintaining saturated UA levels can facilitate osteoporosis prevention.China Clinical Trials Registry: MR-51-23-051741. https://www.medicalresearch.org.cn/search/research/researchViewid=c0e5f868-eca9-4c68-af58-d73460c34028 .

Correlation between uric acid levels and bone mineral density in patients with type 2 diabetes mellitus: a systematic review and meta-analysis

Purpose

To explore the controversial relationship between uric acid (UA) levels and bone mineral density (BMD) in patients with type 2 diabetes mellitus (T2DM).

Patients and methods

The PubMed, Embase, and Cochrane Library databases were searched using keywords and related words. Study quality was evaluated using the Newcastle-Ottawa Scale. Studies retrieved in the literature search were systematically screened to extract information and data based on predefined inclusion and exclusion criteria. RevMan version 5.3 and Stata Release 13.0 were used for statistical analysis. Results are expressed as mean difference (MD) and corresponding 95% confidence interval (CI). Heterogeneity was evaluated using the I2 and Q tests.

Results

This meta-analysis included 10 studies comprising 5,717 patients with T2DM. Study quality ranged from moderate to high. Results of comparative analyses were as follows: normal BMD versus (vs.) osteoporosis (OP) in females, MD -13.83 μmol/L (95% CI -41.69 to 14.03); I2 = 7%; P=0.30); normal BMD vs. osteopenia in females, MD -12.41 μmol/L (95% CI -37.81 to 12.99; I2 = 0%; P=0.92); normal BMD vs. abnormal BMD (osteopenia/OP), MD -23.82 μmol/L (95% CI -33.50 to -14.13; I2 = 0%; P=0.44); and osteopenia vs. OP, MD -22.35 μmol/L (95% CI -29.55 to -15.15; I2 = 5%; P=0.39). No publication bias was observed.

Conclusion

Compared with normal BMD, abnormal BMD (osteopenia/OP) was associated with lower UA levels. Compared with osteopenia, OP also showed lower UA.Systematic review registration.

Nonlinear Association Between Serum Uric Acid and Femoral Neck Bone Mineral Density in Male Patients with Metabolic Dysfunction-Associated Fatty Liver Disease

Purpose

To investigate the relationship between serum uric acid (SUA) levels and femoral neck bone mineral density (BMD) in patients with metabolic dysfunction-associated fatty liver disease (MAFLD).

Patients and Methods

This cross-sectional study included 597 adult inpatients with type 2 diabetes mellitus and ultrasonography-confirmed fatty liver disease. Participants were stratified into tertiles based on femoral neck BMD. Gender-stratified linear regression analyses were performed to assess the relationship between SUA and femoral neck BMD. Nonlinear associations were explored using generalized additive models and two-piece linear regression.

Results

No significant linear association was observed between SUA and femoral neck BMD in either gender (all P > 0.05). However, after adjusting for confounders, a nonlinear relationship was identified in male patients, with a threshold at 388 μmol/L. The effect sizes for SUA levels below and above this threshold were 0.001 (95% CI: 0.000 to 0.002, P = 0.008) and -0.000 (95% CI: -0.002 to 0.000, P = 0.117), respectively. No nonlinear relationship was observed in female patients.

Conclusion

In male MAFLD patients, SUA levels exhibit a nonlinear relationship with femoral neck BMD, with a positive association observed between 300 μmol/L and 388 μmol/L. This relationship was not observed in female patients, suggesting gender-specific effects of SUA on bone health in MAFLD.

Relationship between serum uric acid levels and osteoporosis

Osteoporosis (OP) is a systemic bone disease in which bone density and quality decrease and bone fragility increases due to a variety of causes, making it prone to fractures. The development of OP is closely related to oxidative stress. Uric acid (UA) is the end product of purine metabolism in the human body. Extracellular UA has antioxidant properties and is thought to have a protective effect on bone metabolism. However, the process of UA degradation can lead to intracellular oxidative stress, which together with UA-induced inflammatory factors, leads to increased bone destruction. In addition, UA can inhibit vitamin D production, resulting in secondary hyperparathyroidism and further exacerbating UA-associated bone loss. This review summarizes the relationship between serum UA levels and bone mineral density, bone turnover markers, and so on, in the hope of providing new insights into the pathogenesis and treatment of OP.

Biochemical Markers of Bone Fragility in Patients with Diabetes. A Narrative Review by the IOF and the ECTS

CONTEXT

The risk of fragility fractures is increased in both type 1 and type 2 diabetes. Numerous biochemical markers reflecting bone and/or glucose metabolism have been evaluated in this context. This review summarizes current data on biochemical markers in relation to bone fragility and fracture risk in diabetes.

METHODS

Literature review by a group of experts from the International Osteoporosis Foundation (IOF) and European Calcified Tissue Society (ECTS) focusing on biochemical markers, diabetes, diabetes treatments and bone in adults.

RESULTS

Although bone resorption and bone formation markers are low and poorly predictive of fracture risk in diabetes, osteoporosis drugs seem to change bone turnover markers in diabetics similarly to non-diabetics, with similar reductions in fracture risk. Several other biochemical markers related to bone and glucose metabolism have been correlated with BMD and/or fracture risk in diabetes, including osteocyte-related markers such as sclerostin, HbA1c and advanced glycation end products (AGEs), inflammatory markers and adipokines, as well as IGF-1 and calciotropic hormones.

CONCLUSION

Several biochemical markers and hormonal levels related to bone and/or glucose metabolism have been associated with skeletal parameters in diabetes. Currently, only HbA1c levels seem to provide a reliable estimate of fracture risk, while bone turnover markers could be used to monitor the effects of anti-osteoporosis therapy.

Prevalence of osteoporosis in patients with diabetes mellitus: a systematic review and meta-analysis of observational studies

BACKGROUND

Osteoporosis (OP) and diabetes mellitus (DM) are two major healthcare issues in the world. Numerous population based-studies have reported an increased prevalence of OP among individuals with DM, though, estimates vary significantly.

PURPOSE

The objective of this study is to estimate the prevalence of OP in patients with DM.

METHODS

To identify relevant literature, PubMed, Embase, Medline, CBM and Cochrane Library were searched for studies published from inception till July 2022, The search was conducted, and studies were included without countries and language restrictions. For full-text articles included in the study, the references were also independently searched. Random inverse variance-weighted models were used by Stata version 17.0 to estimate the prevalence of OP in patients with diabetes across studies. The heterogeneity was examined with I² via the χ² test on Cochrane's Q statistic. Subgroup analysis and meta-regression were used to explore potential sources of heterogeneity. Egger's test was used to assess publication bias.

RESULTS

A high OP prevalence of 27.67% (95% confidence interval (CI) 21.37-33.98%) was found in a pooled analysis of 21 studies involving 11,603 T2DM patients. Methodological value of the included articles was high, with only three medium-quality studies and no low-quality studies. A significantly high heterogeneity (I² = 98.5%) was observed.

CONCLUSIONS

Worldwide, a high prevalence of OP was found in patients with T2DM. Therefore, strong measures to prevent and treat osteoporosis in diabetic patients are required.

TRIAL REGISTRATION

This study has been registered on PROSPERO, number CRD42021286580 .