Impact Of Serum Glycation Products On Bone Health In Sedentary Patients With Type 2 Diabetes

Glycation products are linked to lower bone mineral density (BMD) by altering bone collagen structure, compromising strength, and increasing fracture risk. While exercise can reduce hyperglycemia and insulin resistance, a sedentary lifestyle elevates serum glycated product levels in type 2 diabetes, making it essential to examine the relationship between these products and bone health in sedentary T2DM patients. PURPOSE: To assess the association between early glycation products (glycated hemoglobin - HbA1c, glycated albumin - ALB-g) and an advanced glycation end product (Pentosidine - PTD) with BMD and other bone health indicators in sedentary individuals with T2DM and non-diabetic (non-DM) controls, stratified by sex and menopausal status. METHODS: This study included 204 sedentary adults from southeastern Mexico. Physical activity was assessed via IPAQ, while BMD and fat mass were measured using DXA. HbA1c, PTD, ALB-g, and fasting glucose were analyzed. Correlation tests and binary logistic regression were used. RESULTS: Participants included 112 (55%) T2DM and 92 (45%) non-DM, all sedentary. The T2DM group had 46 men and 66 women, a median age of 50 (IQR 11), while non-DM median age was 55.5 (IQR 13). Mean BMI was 30.9 kg/m2 (SD = 5.3) in T2DM and 27.7 kg/m2 (SD = 4.8) in non-DM. A negative correlation (p ≤ 0.05) was found between HbA1c and BMD in the arms and legs in T2DM. In non-DM, HbA1c negatively correlated with pelvic BMD (r = -0.345, p = 0.018). A positive association was seen between HbA1c and adiposity in T2DM (p ≤ 0.05). ALB-g negatively correlated with fat mass (r = -0.316, p = 0.030) in T2DM. PTD inversely correlated with BMD in anatomical regions among postmenopausal women with T2DM (p ≤ 0.05), while in non-postmenopausal women, only Waist-to-Height ratio was significant. Logistic regression showed PTD (OR 1.104, p = 0.047) predicted osteopenia/osteoporosis in T2DM postmenopausal women, while HbA1c (OR 1.443, p = 0.048) and fat mass (OR 1.011, p = 0.023) were risk factors in the sample. CONCLUSIONS: Glycated products, particularly PTD and HbA1c, negatively impact bone health and fat mass, with stronger effects in women, especially postmenopausal. Elevated HbA1c, fat mass, and PTD (in postmenopausal women) may predict low bone mass. Future studies should incorporate 3D bone assessment methods.