Distinct Bone Turnover Alterations Across Glycemic Phenotypes of Type 2 Diabetes and the Role of a Comprehensive Nutritional Index in Postmenopausal Women.
- 1Department of Laboratory Medicine, College of Medicine, Inha University, Incheon, Republic of Korea.
- 2Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
- 3Department of Internal Medicine, Teikyo University Chiba Medical Center, Chiba, Japan.
Abstract
Bone metabolic activity can be estimated using bone turnover markers (BTMs), such as C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP). Few studies have examined differences in BTM levels among type 2 diabetes (T2D) phenotypes. This study investigated the relationships between BTMs, the comprehensive nutritional index (CNI), insulin resistance, and inflammatory status across these phenotypes. A total of 683 postmenopausal women with T2D were evaluated. BTMs and high-sensitivity C-reactive protein (hsCRP) levels were measured. The P1NP/CTX (P/C) ratio and homeostatic model assessment of insulin resistance (HOMA-IR) were calculated. Nutritional status was assessed using the controlling nutritional status score and the CNI. Patients were categorized into three subgroups: hemoglobin A1c-defined T2D (A-T2D), fasting plasma glucose-defined T2D (G-T2D), and combined T2D (GA-T2D). The G-T2D and GA-T2D phenotypes had significantly higher CTX levels but lower P/C ratios than the A-T2D phenotype. Compared to the A-T2D group, the G-T2D and GA-T2D groups demonstrated increased HOMA-IR, hsCRP levels, and malnutrition prevalence. Patients with malnutrition exhibited significant elevations in both CTX and P1NP levels. Trend analysis revealed that lower CNI scores were closely associated with higher CTX levels and lower P/C ratios (p for trend < 0.001). The CNI was strongly associated with decreased odds of high CTX levels (odds ratio [OR]: 0.785, p < 0.001) and increased odds of high P1NP levels (OR: 1.203, p < 0.001). The CNI demonstrated better discriminative performance for identifying high CTX levels than traditional nutritional indices. Bone turnover differs significantly across T2D phenotypes, with the G-T2D and GA-T2D groups showing more pronounced alterations than the A-T2D group, which may be linked to insulin resistance, chronic inflammation, and compromised nutritional status. Evaluating the CNI could facilitate the exploratory evaluation of bone turnover imbalance in postmenopausal women with T2D.
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BibTeX
@article{choi2026distinct,
title = {{Distinct Bone Turnover Alterations Across Glycemic Phenotypes of Type 2 Diabetes and the Role of a Comprehensive Nutritional Index in Postmenopausal Women.}},
author = {Jong Weon Choi and Noriyoshi Fujii and Tatsuyoshi Fujii},
journal = {International journal of general medicine},
year = {2026},
month = oct,
doi = {10.2147/ijgm.s653696},
url = {https://europepmc.org/article/MED/42953775},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Distinct Bone Turnover Alterations Across Glycemic Phenotypes of Type 2 Diabetes and the Role of a Comprehensive Nutritional Index in Postmenopausal Women.
AU - Jong Weon Choi
AU - Noriyoshi Fujii
AU - Tatsuyoshi Fujii
PY - 2026
DA - 2026/10/24
JO - International journal of general medicine
DO - 10.2147/ijgm.s653696
UR - https://europepmc.org/article/MED/42953775
AB - Bone metabolic activity can be estimated using bone turnover markers (BTMs), such as C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP). Few studies have examined differences in BTM levels among type 2 diabetes (T2D) phenotypes. This study investigated the relationships between BTMs, the comprehensive nutritional index (CNI), insulin resistance, and inflammatory status across these phenotypes. A total of 683 postmenopausal women with T2D were evaluated. BTMs and high-sensitivity C-reactive protein (hsCRP) levels were measured. The P1NP/CTX (P/C) ratio and homeostatic model assessment of insulin resistance (HOMA-IR) were calculated. Nutritional status was assessed using the controlling nutritional status score and the CNI. Patients were categorized into three subgroups: hemoglobin A1c-defined T2D (A-T2D), fasting plasma glucose-defined T2D (G-T2D), and combined T2D (GA-T2D). The G-T2D and GA-T2D phenotypes had significantly higher CTX levels but lower P/C ratios than the A-T2D phenotype. Compared to the A-T2D group, the G-T2D and GA-T2D groups demonstrated increased HOMA-IR, hsCRP levels, and malnutrition prevalence. Patients with malnutrition exhibited significant elevations in both CTX and P1NP levels. Trend analysis revealed that lower CNI scores were closely associated with higher CTX levels and lower P/C ratios (p for trend < 0.001). The CNI was strongly associated with decreased odds of high CTX levels (odds ratio [OR]: 0.785, p < 0.001) and increased odds of high P1NP levels (OR: 1.203, p < 0.001). The CNI demonstrated better discriminative performance for identifying high CTX levels than traditional nutritional indices. Bone turnover differs significantly across T2D phenotypes, with the G-T2D and GA-T2D groups showing more pronounced alterations than the A-T2D group, which may be linked to insulin resistance, chronic inflammation, and compromised nutritional status. Evaluating the CNI could facilitate the exploratory evaluation of bone turnover imbalance in postmenopausal women with T2D.
SN - 1178-7074
ER -