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. 2024 Jan 22:15:1305713.
doi: 10.3389/fendo.2024.1305713. eCollection 2024.

Hemoglobin is associated with BMDs and risk of the 10-year probability of fractures in patients with type 2 diabetes mellitus

Ren-Xuan Li #  1   2   3   4   5   6   7 , Na Xu #  2   3   4   5   6   7 , Yu-Ning Guo  2   3   4   5   6   7 , Yan Wang  2   3   4   5   6   7 , Yan-Wei Liang  2   3   4   5   6   7   8 , Xiao-Lian Zhou  2   3   4   5   6   7   8 , Wen-Tong Jiang  2   3   4   5   6   7 , Jian-Xia Wei  2   3   4   5   6   7 , Xin-Yuan Zhang  2   3   4   5   6   7 , Li-Na Zhou  2   3   4   5   6   7   8 , Lei Zhu  9 , Yan-Man Zhou  10   11 , Jin Xu  1   2   3   4   5   6   7
Affiliations

Hemoglobin is associated with BMDs and risk of the 10-year probability of fractures in patients with type 2 diabetes mellitus

Ren-Xuan Li et al. Front Endocrinol (Lausanne). .

Abstract

Purpose: This study aimed to investigate the associations between hemoglobin (HGB) levels and bone mineral density (BMD) and fracture risk in type 2 diabetes mellitus(T2DM) population of different ages.

Method: This cross-sectional study included 641 patients with T2DM (57.9% males). BMD of the femoral neck (FN), total hip (TH), and lumbar spine (LS) were measured using dual-energy X-ray absorptiometry. The 10-year probability of fracture was assessed using a fracture risk assessment tool (FRAX). HGB and other biochemical indices were measured in a certified laboratory at our hospital. Statistical analysis was performed using SPSS 26.0 and R language (R version 4.1.0). Generalized additive models (GAMs) were used to identify the associations between HGB and BMD and fracture risk.

Results: Patients with osteoporosis have lower HGB levels than the non-osteoporotic population and lower FN BMD in patients with anemia than in the non-anemic population. In patients with T2DM, there was sex- and age-related variability in the correlation between HGB levels and BMDs and fracture risk. In older men, HGB level was an independent determinant of BMD and was positively correlated with FN and TH BMD. In non-older women, HGB level was an independent determinant of BMD and fracture risk, positively associated with BMDs and negatively associated with 10-year probability of fracture risk. GAMs revealed a positive linear association between HGB level and BMDs in non-older female patients but not in older male patients.

Conclusion: Our study provides a new perspective on the association of HGB level and BMDs with fracture risk. Relatively high HGB levels are a protective factor for bone quality in patients with T2DM. However, the bone-protective effect of HGB is influenced by age and sex and persists only in older men and non-older women with T2DM.

Keywords: bone mineral density; fracture risk; hemoglobin; osteoporosis; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
FN BMD (A), TH BMD (B) and LS BMD (C) according to different anemia status in different subgroups stratified by age and sex. 1. non-older men, 2. older men, 3. non-older women, 4. older women.
Figure 2
Figure 2
GAMs analysis of HGB with FN BMD (A) and TH BMD (B) in older men. The solid black line represents the smooth curve fit between variables. Gray bands represent the 95% confidence interval from the fit. Adjusted for ALP, HDL, HbA1c, SCR and 25-VIT D.
Figure 3
Figure 3
GAMs analysis of HGB with FN BMD (A), TH BMD (B), LS BMD (C), MOF (D) and HF (E) in non-older women. The solid black line represents the smooth curve fit between variables. Gray bands represent the 95% confidence interval from the fit. Adjusted for ALP, HDL, HbA1c, SCR and 25-VIT D.
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