Association between C-reactive protein-triglyceride glucose index and abnormal BMD in middle-aged and elderly patients with type 2 diabetes mellitus: a cross-sectional study

Yuan ZhangGuanhua ChenYali Jing^*

• Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Liaoning Province, China

Background and aims Type 2 diabetes mellitus (T2DM) is associated with poor bone health, and insulin resistance (IR) and inflammation are common pathologic mechanisms in T2DM and osteopenia/osteoporosis (OP). C-reactive protein-triglyceride glucose index (CTI), a novel marker of IR and inflammation, has been Investigated in various diseases. However, its potential association with the incidence of T2DM combined osteopenia/OP in T2DM remains unclear. This study aimed to investigate the association between the CTI and osteopenia/OP in middle-aged and elderly patients with T2DM. Methods This retrospective cross-sectional study analyzed 847 middle-aged and elderly patients with T2DM. The CTI was calculated as follows: 0.412×Ln (CRP [mg/L])+Ln (TG [mg/dl]×FPG [mg/dl])/2. Spearman correlation analysis was employed to explore the connection among CTI with bone metabolic parameters in T2DM. Further, CTI was included in the logistic regression model as a continuous and categorical variable, respectively, to assess the association between this index and osteopenia/OP in T2DM. Additionally, the operating Characteristic (ROC) curve analysis was adopted to examine the predictive efficacy of the CTI for osteopenia/OP in T2DM. Results This study found that the CTI level was significant higher in osteopenia/OP patients than normal subjects with T2DM (9.179±0.500 vs. 9.684±0.514, p<0.001). Participants stratified by CTI quartiles showed a progressively increased prevalence of osteopenia/OP with higher CTI levels (22.6% to 77.7%, p for trend < 0.001). In Spearman correlation analysis, a remarkably negative correlation was observed between CTI and bone mineral density (BMD) measures in middle-aged and elderly patients with T2DM. When analyzed CTI as continuous variable, after adjustment for the impact of various covariates, there was a significant relationship between CTI and the risk of osteopenia/OP (OR 7.277, 95% CI: 4.602~11.507; p<0.001). When categorized CTI into quartiles, it still showed a statistically significant association with osteopenia/OP. The area under the ROC curve (AUC) showed a modest standalone predictive ability of 0.758 (95% CI: 0.7254-0.7897; specificity=69.3%; sensitivity= 71.2%). Conclusion A high CTI is associated with an increased risk of osteopenia/OP in middle-aged and elderly patients with T2DM. Incorporation of routine CTI monitoring into clinical practice may facilitate early detection of high-risk individuals.