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Peer-reviewedCC BYJournal of diabetes

Diabetic Peripheral Neuropathy With Low Appendicular Muscle Mass Is Associated With Osteoporosis, Falls, and Fractures.

  • Biao Zheng1,2,3,4,5,6
  • Yongze Zhang1,2,3,4,5,6
  • Dan Liang1,2,3,4,5,6
  • Ximei Shen1,2,3,4,5,6
  • Lingning Huang1,2,3,4,5,6
  • Fengying Zhao1,2,3,4,5,6
  • Sunjie Yan1,2,3,4,5,6
6 affiliations
  1. 1Department of Endocrinology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
  2. 2Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
  3. 3Clinical Research Center for Metabolic Diseases of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
  4. 4Fujian Key Laboratory of Glycolipid and Bone Mineral Metabolism, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
  5. 5Diabetes Research Institute of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
  6. 6Metabolic Diseases Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
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Abstract

Introduction

Diabetic peripheral neuropathy (DPN) and low appendicular muscle mass (LAMM) may jointly contribute to adverse skeletal outcomes, but their combined effects remain unclear. We examined their associations with osteoporosis, falls, and fractures in patients with Type 2 diabetes.Methods

We explored associations of diabetes and grip strength with skeletal outcomes using SHARE v8.0.0 (327 248 participants). The primary analysis used a cohort of patients with Type 2 diabetes from the First Affiliated Hospital of Fujian Medical University. LAMM was defined using dual-energy X-ray absorptiometry-derived appendicular skeletal muscle mass index. Associations of clinically diagnosed DPN, LAMM, and their coexistence with osteoporosis, falls, and fractures were evaluated using logistic regression and Cox survival models. Exploratory serum antibody omics was performed.Results

In SHARE, grip strength was inversely associated with all three outcomes. In the local cohort, coexisting DPN and LAMM were associated with higher odds of osteoporosis (OR 2.151, 95% CI 1.645-2.805), falls (OR 4.667, 95% CI 3.406-6.376), and fractures (OR 2.416, 95% CI 1.367-3.515; all p < 0.001). Cox analyses showed higher hazards of osteoporosis (HR 3.410, 95% CI 1.579-7.362; p = 0.002) and falls (HR 4.385, 95% CI 1.838-10.459; p < 0.001), but not fractures (HR 0.708, 95% CI 0.187-2.675; p = 0.611). Antibody omics suggested a reactivity profile involving endoplasmic reticulum protein processing and neurodegeneration-related pathways.Conclusion

Coexisting DPN and LAMM were associated with higher odds of all three skeletal outcomes and higher longitudinal hazards of osteoporosis and falls, but not fractures. The exploratory omics findings require functional validation.

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Cite

BibTeXRIS
BibTeX
@article{zheng2026diabetic,
  title = {{Diabetic Peripheral Neuropathy With Low Appendicular Muscle Mass Is Associated With Osteoporosis, Falls, and Fractures.}},
  author = {Biao Zheng and Yongze Zhang and Dan Liang and Ximei Shen and Lingning Huang and Fengying Zhao and Sunjie Yan},
  journal = {Journal of diabetes},
  year = {2026},
  month = oct,
  doi = {10.1111/1753-0407.70276},
  url = {https://europepmc.org/article/MED/42949208},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Diabetic Peripheral Neuropathy With Low Appendicular Muscle Mass Is Associated With Osteoporosis, Falls, and Fractures.
AU  - Biao Zheng
AU  - Yongze Zhang
AU  - Dan Liang
AU  - Ximei Shen
AU  - Lingning Huang
AU  - Fengying Zhao
AU  - Sunjie Yan
PY  - 2026
DA  - 2026/10/28
JO  - Journal of diabetes
DO  - 10.1111/1753-0407.70276
UR  - https://europepmc.org/article/MED/42949208
AB  - Introduction  Diabetic peripheral neuropathy (DPN) and low appendicular muscle mass (LAMM) may jointly contribute to adverse skeletal outcomes, but their combined effects remain unclear. We examined their associations with osteoporosis, falls, and fractures in patients with Type 2 diabetes.Methods  We explored associations of diabetes and grip strength with skeletal outcomes using SHARE v8.0.0 (327 248 participants). The primary analysis used a cohort of patients with Type 2 diabetes from the First Affiliated Hospital of Fujian Medical University. LAMM was defined using dual-energy X-ray absorptiometry-derived appendicular skeletal muscle mass index. Associations of clinically diagnosed DPN, LAMM, and their coexistence with osteoporosis, falls, and fractures were evaluated using logistic regression and Cox survival models. Exploratory serum antibody omics was performed.Results  In SHARE, grip strength was inversely associated with all three outcomes. In the local cohort, coexisting DPN and LAMM were associated with higher odds of osteoporosis (OR 2.151, 95% CI 1.645-2.805), falls (OR 4.667, 95% CI 3.406-6.376), and fractures (OR 2.416, 95% CI 1.367-3.515; all p < 0.001). Cox analyses showed higher hazards of osteoporosis (HR 3.410, 95% CI 1.579-7.362; p = 0.002) and falls (HR 4.385, 95% CI 1.838-10.459; p < 0.001), but not fractures (HR 0.708, 95% CI 0.187-2.675; p = 0.611). Antibody omics suggested a reactivity profile involving endoplasmic reticulum protein processing and neurodegeneration-related pathways.Conclusion  Coexisting DPN and LAMM were associated with higher odds of all three skeletal outcomes and higher longitudinal hazards of osteoporosis and falls, but not fractures. The exploratory omics findings require functional validation.
SN  - 1753-0393
SN  - 1753-0407
ER  -