The diabetic neuropathy and bone mineral density in type 2 diabetes mellitus: a cross-sectional and meta-analytic study

Diabetic neuropathy (DN) is a common complication of type 2 diabetes mellitus (T2DM), yet its impact on bone mineral density (BMD) remains unclear. This study combines cross-sectional and meta-analytic methods to comprehensively explore the relationship between DN and osteoporosis in T2DM patients. The cross-sectional study included 523 T2DM patients, classified into DN and non-DN groups. BMD was measured using dual-energy X-ray absorptiometry (DXA), and multivariate analysis identified osteoporosis-related factors. The meta-analysis included studies published from 1999 to 2021, comparing BMD between patients with and without DN. The results showed that while significant differences in clinical characteristics and biochemical indices (such as age, HbA1c, and 25(OH) vitamin D levels) were observed between the groups, no significant association between DN and osteoporosis was found after adjusting for covariates like body mass index and blood pressure. Additionally, the meta-analysis confirmed no significant impact of DN on BMD across skeletal sites, including the lumbar spine, hip, and femoral neck. These findings suggest that while DN may indirectly affect bone health through alterations in bone metabolism (such as bone formation markers), its direct impact on BMD is limited. The study's limitations include its cross-sectional design, which restricts causal inference, and retrospective data collection, underscoring the need for prospective studies to further elucidate the mechanisms behind DN's effects on bone health. These results highlight the complex interplay of factors influencing osteoporosis risk in T2DM and underscore the importance of a multifactorial approach to bone health management in this population.