Association between neutrophil percentage-to-albumin ratio and bone mineral density and prevalent osteoporosis in patients with type 2 diabetes mellitus.

BACKGROUND

Patients with type 2 diabetes mellitus (T2DM) have an increased risk of osteoporosis and fragility fractures. Chronic low-grade inflammation and nutritional imbalance are key underlying mechanisms. The neutrophil percentage-to-albumin ratio (NPAR) is a novel biomarker reflecting both processes, but its role in osteoporosis remains unclear. This study aimed to investigate the association between NPAR and bone mineral density (BMD), as well as prevalent osteoporosis, in patients with T2DM.

METHODS

This retrospective cross-sectional study included 259 patients with T2DM. Osteoporosis was diagnosed according to the World Health Organization (WHO) criteria based on dual-energy X-ray absorptiometry results. Logistic regression was used to assess the association between NPAR andprevalent osteoporosis. Linear regression evaluated its relationship with BMD at the femoral neck and total hip. Receiver operating characteristic analysis assessed its concurrent discriminative capacity for prevalent osteoporosis.

RESULTS

NPAR levels were higher in the osteoporosis group (P = 0.004). NPAR was independently associated with osteoporosis (OR = 3.42, 95% CI: 1.10-10.64, P = 0.034). It was negatively associated with femoral neck BMD (b = -0.08, 95% CI: -0.14 to -0.02, P = 0.009) and total hip BMD (b = -0.08, 95% CI: -0.14 to -0.01, P = 0.020). The AUC was 0.62 (95% CI: 0.54-0.71, P = 0.004).

CONCLUSION

Given its modest concurrent discriminative ability, NPAR should be interpreted in combination with other clinical indicators rather than used as an independent screening marker for disease diagnosis, but may provide supplementary information regarding prevalent osteoporosis in patients with T2DM.