Does bone health differ between patients of chronic kidney disease with and without type 2 diabetes mellitus? - A comparative cross-sectional study.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is associated with alterations in bone metabolism, bone strength, and quality. There is limited literature available regarding the effect of diabetes mellitus (DM) on chronic kidney disease-mineral and bone disorder (CKD-MBD). The study aimed to compare bone mineral health in pre-dialysis CKD patients with and without DM. MATERIALS AND METHODS: This cross-sectional study included patients with CKD G3-5 (age ≥ 40 years) categorized into CKD-DM or CKD-non-DM(CKD-NDM) groups. Bone mineral density (BMD), trabecular bone score (TBS), and hip structural analysis (HSA) were assessed using dual-energy X-ray absorptiometry (DXA). Vertebral fractures (VFs) were assessed by lateral dorsolumbar spine radiography. RESULTS: Of 306 CKD patients (n = 153 per group) age was comparable (57.42 ± 9.6 vs. 56.1 ± 9.2 years; p = 0.23), CKD-DM patients had higher body mass index, waist circumference and estimated glomerular filtration rate. After adjusting for confounders, there was no difference in the prevalence of osteoporosis between CKD-DM and CKD-NDM groups (22.9% vs. 34%, p = 0.208). However, the prevalence of osteoporosis at distal forearm (FA) was higher in CKD-NDM (34.9% vs. 50.7%, p = 0.024). The mean TBS (1.341 ± 0.113 vs. 1.358 ± 0.142; p = 0.722) and prevalence of abnormal TBS were similar, though CKD-NDM had higher proportion of patients with degraded TBS(≤1.23) (11.8% vs. 20.3%, p = 0.007). In CKD-NDM, the buckling ratio at femoral shaft was significantly higher and neck-shaft angle was wider. Morphometric VFs were comparable between groups. CONCLUSION: In this cohort of patients with pre-dialysis CKD, the prevalence of osteoporosis, abnormal TBS and morphometric VFs were similar between subjects with and without DM. However, CKD-NDM group demonstrated higher rates of forearm osteoporosis and degraded TBS, as well as high risk HSA parameters.