Association Between Vitamin D Deficiency and Bone Mineral Density in Type 2 Diabetes: A cross-sectional study
Vitamin D Deficiency and Bone Mineral Density in Type 2 Diabetes
DOI:
https://doi.org/10.69750/dmls.02.08.0147Keywords:
Type 2 diabetes mellitus, vitamin D, 25(OH)D, bone mineral density, DXA, osteoporosis, hypovitaminosis D, South Asia, HbA1c, densitometryAbstract
Background: People with type 2 diabetes mellitus (T2DM) sustain more fractures than peers despite often normal areal bone mineral density (BMD). Vitamin D deficiency is common in South Asia and may worsen diabetic skeletal fragility.
Objectives: To assess the association between serum 25-hydroxyvitamin D [25(OH)D] and BMD in adults with long-standing T2DM.
Methods: A Multicenter cross-sectional study at two tertiary hospitals in Punjab, Pakistan was conducted. Current study enrolled 110 adults aged 40–75 years with T2DM duration ≥5 years. Fasting 25(OH)D was measured by LC–MS/MS. Lumbar-spine (L1–L4) and femoral-neck BMD were measured by DXA. Multivariable linear models related 25(OH)D (per 10-ng/mL and categories: deficient <20 ng/mL; insufficient 20–29; sufficient ≥30) to site-specific BMD, adjusting for age, sex, BMI, diabetes duration, HbA1c, eGFR, lifestyle factors, diet, and thiazolidinedione use.
Results: Participants were 57.2±8.6 years; 52.7% women; BMI 28.9±4.7 kg/m²; diabetes duration 10.5 years. Vitamin D deficiency and insufficiency were present in 62.7% and 24.5%. Each 10-ng/mL higher 25(OH)D associated with +0.029 g/cm² (95% CI 0.014–0.044) lumbar and +0.025 g/cm² (0.011–0.039) femoral-neck BMD. Versus sufficiency, deficiency associated with −0.071 and −0.056 g/cm² lower lumbar and femoral-neck BMD; insufficiency showed intermediate deficits. Associations were stronger in women and in participants with HbA1c ≥8%; no strong nonlinearity was detected.
Conclusions: Lower 25(OH)D independently relates to lower axial and femoral BMD in T2DM. Integrating vitamin D evaluation and correction into diabetes bone care is clinically prudent while fracture-endpoint trials are pursued.
Downloads
References
Hofbauer LC, Rachner TD, Hamann C, Schoppen S, Rauner M. Bone fragility in diabetes: novel concepts and clinical implications. Lancet Diabetes Endocrinol. 2022;10(4):284–296. doi:10.1016/S2213-8587(21)00347-8.
Li GF, Zhao PP, Xiao WJ, Karasik D, Xu YJ, Zheng HF. The paradox of bone mineral density and fracture risk in type 2 diabetes. Endocrine. 2024;85(3):1100–1103. doi:10.1007/s12020-024-03926-w.
Giangregorio LM, Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, et al. FRAX underestimates fracture risk in patients with diabetes. J Bone Miner Res. 2012;27(2):301–308. doi:10.1002/jbmr.556.
Leslie WD, Aubry-Rozier B, Lamy O, Hans D. TBS (trabecular bone score) and diabetes-related fracture risk. J Clin Endocrinol Metab. 2013;98(2):602–609. doi:10.1210/jc.2012-3118.
Leslie WD, Johansson H, McCloskey EV, Harvey NC, Kanis JA, Oden A, et al. Comparison of methods for improving fracture risk assessment in type 2 diabetes: The Manitoba BMD Registry. J Bone Miner Res. 2018;33(11):1923–1930. doi:10.1002/jbmr.3521.
Shuhart CR, Yeap SS, Anderson PA, Jankowski LG, Lewiecki EM, Morse LR, et al. Executive summary of the 2019 ISCD Position Development Conference. J Clin Densitom. 2019;22(4):453–471. doi:10.1016/j.jocd.2019.07.001.
Krueger D, Tanner B, Szalat A, Agarwal S, Shuhart CR, Shepherd JA, et al. DXA reporting updates: 2023 official positions of the International Society for Clinical Densitometry. J Clin Densitom. 2024;27(3):101437. doi:10.1016/j.jocd.2023.101437.
Gani LU, Sritara C, Blank RD, Chen W, Gilmour J, Dhaliwal R, et al. Follow-up bone mineral density testing: 2023 ISCD official positions. J Clin Densitom. 2024;27(1):101440. doi:10.1016/j.jocd.2023.101440.
LeBoff MS, Chou SH, Ratliff KA, Cook NR, Khurana B, Kim E, et al. Supplemental vitamin D and incident fractures in midlife and older adults. N Engl J Med. 2022;387(4):299–309. doi:10.1056/NEJMoa2202106.
Voulgaridou G, Christou GA, Chasan ZT, Goulis DG. Vitamin D and calcium in osteoporosis and the role of bone turnover markers: a narrative review. Nutrients. 2023;15(3):721. doi:10.3390/nu15030721.
Fischer C, de Jongh E, Kemmler W, Shojaa M, Beaudart C, Bruyère O, et al. Additive effects of exercise and vitamin D supplementation on bone mineral density: systematic review and meta-analysis. Osteoporos Int. 2023;34(8):1535–1550. doi:10.1007/s00198-023-06683-5.
Kong SH, Jang HC, Kim JH. Effect of vitamin D supplementation on risk of fractures and falls: a network meta-analysis. Endocrinol Metab (Seoul). 2022;37(2):274–284. doi:10.3803/EnM.2021.1374.
Demay MB, Autier P, Bouillon R, Dawson-Hughes B, Durazo-Arvizu RA, Gallo S, et al. Vitamin D for the prevention of disease: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2024;109(8):1907–1947. doi:10.1210/clinem/dgae290.
Shah VP, Bauer DC, Bolland MJ, Bouillon R, Camargo CA Jr, Dawson-Hughes B, et al. Evidence review supporting the Endocrine Society guideline on vitamin D for disease prevention. J Clin Endocrinol Metab. 2024;109(8):1948–1970. doi:10.1210/clinem/dgae291.
Cui A, Ma Y, Zhou F, Xiao P, Fan Z, Zheng J, et al. Global and regional prevalence of vitamin D deficiency from 2000 to 2022: a systematic review and meta-analysis. Front Nutr. 2023;10:1070808. doi:10.3389/fnut.2023.1070808.
Siddiqee MH, Bhattacharjee B, Siddiqi UR, Rahman MM. High prevalence of vitamin D deficiency among South Asian adults: a systematic review and meta-analysis. BMC Public Health. 2021;21(1):1823. doi:10.1186/s12889-021-11888-1.
Nimitphong H, Holick MF. Vitamin D status and sun exposure in Southeast Asia. Dermatoendocrinol. 2013;5(1):34–37. doi:10.4161/derm.24054.
Saito M, Marumo K. Effects of collagen crosslinking on bone material properties in health and disease. Calcif Tissue Int. 2015;97(3):242–261. doi:10.1007/s00223-015-9985-5.
Willett TL, Paschalis EP. A critical review of advanced glycation end products (AGEs) and bone: mechanisms and clinical relevance. Bone. 2022;164:116505. doi:10.1016/j.bone.2022.116505.
Rungratanawanich W, Qu Y, Wang X, Essa MM, Song BJ. Advanced glycation end products (AGEs) and other adducts in aging-related diseases and alcoholic tissue injury. Exp Mol Med. 2021;53(2):168–188. doi:10.1038/s12276-021-00561-7.
Martínez SB, Blanco-Rojo R, Vaquero MP. The diabetic paradox: bone mineral density and fracture in type 2 diabetes. Endocrinol Nutr. 2016;63(9):495–501. doi:10.1016/j.endonu.2016.06.004.
Chen RD, Wei XJ, Tian JH, Yang KH, Cao X. Hypoglycemic agents and bone health: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2023;14:1022279. doi:10.3389/fendo.2023.1022279.
Viscoli CM, Inzucchi SE, Young LH, Insogna KL, Conwit R, Furie KL, et al. Pioglitazone and risk for bone fracture: safety data from a randomized clinical trial. J Clin Endocrinol Metab. 2017;102(3):914–922. doi:10.1210/jc.2016-3177.
Colhoun HM, Livingstone SJ, Looker HC, Morris AD, Wild SH, Lindsay RS, et al. Hospitalised hip fracture risk with rosiglitazone and pioglitazone use compared with other glucose-lowering drugs. Diabetologia. 2012;55(11):2929–2937. doi:10.1007/s00125-012-2668-0.
Chen W, Sun J, Li Y, Liu J, Wu H. Fracture risk assessment in diabetes mellitus. Front Endocrinol (Lausanne). 2022;13:961761. doi:10.3389/fendo.2022.961761.
Downloads
PlumX Metrics
Published
Issue
Section
License
© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License , which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third-party material in this article are included in the article’s Creative Commons license unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you must obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
How to Cite
