Nandong Hu,1,2,* Yiping Zhang,2,* Zicheng Wei,2 Rui Yu,2 Yingying Zhang,3 Xiao Chen2 

1Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong Universty, Shanghai, 200127 People’s Republic of China; 2Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People’s Republic of China; 3Department of Cardiology, the First People’s Hospital of Taian, Tai’an, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xiao Chen, Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People’s Republic of China, Email chxwin@163.com Yingying Zhang, Department of Cardiology, the First People’s Hospital of Taian, Tai’an, People’s Republic of China, Email yyzhang001@outlook.com

Purpose: Renal dysfunction and vertebral fracture are both common in patients with type 2 diabetes mellitus (T2DM). However, the association between renal dysfunction and vertebral fracture has rarely been evaluated longitudinally. In this longitudinal study, we evaluated the associations between different subtypes of renal dysfunction and vertebral fracture (VF) in patients with type 2 diabetes.
Methods: This study recruited T2DM patients aged 50 years or older whose computed tomography (CT) imaging screening revealed no VFs from January 2019–December 2021. The participants were followed up annually until January 2024. The Genant score was used to define new-onset VFs. The renal dysfunction phenotypes were as follows: no renal dysfunction, estimated glomerular filtration rate (eGFR) decline or proteinuria, and eGFR decline + proteinuria. Cox proportional hazards models were used to assess the association between renal dysfunction and VF.
Results: A total of 135 patients developed new VFs over a median follow-up period of two years. A total of 270 patients without fractures were matched according to follow-up time and body mass index. Bone CT attenuation (HU) (adjusted hazard ratio (HR) = 0.97, 95% confidence interval (CI) 0.99– 0.99) was independently associated with VF. eGFR decline or proteinuria and eGFR decline + proteinuria were associated with VF (adjusted HR = 1.98, 95% CI 1.35– 2.92; adjusted HR = 2.53, 95% CI 1.30– 4.92). Subgroup analyses revealed associations in women, patients without accompanying neuropathy, patients without vascular lesions, and patients who did not receive insulin therapy. The addition of renal dysfunction improved the area under the curve of the clinical model from 0.817 (95% CI: 0.78– 0.85) to 0.839 (95% CI: 0.80– 0.87) (p < 0.05).
Conclusion: Renal dysfunction was associated with VF in patients with T2DM. The addition of renal dysfunction improved the ability of bone mass to predict VF.

Keywords: type 2 diabetes mellitus, renal dysfunction, vertebral fracture