Linear Inverse Association Between Triglyceride Glucose-Body Mass Index and Osteoporosis in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

Lingfan Zhou,1,2 Fengjiao Zhang,2 Zhenwei Wang,3 Zhiqiang Kang2 1Department of Endocrinology, Henan Medical University Affiliated Zhengzhou Central Hospital, Zhengzhou, 450000, People’s Republic of China; 2Department of Endocrinology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, 450000, People’s Republic of China; 3Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People’s Republic of ChinaCorrespondence: Zhenwei Wang, Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People’s Republic of China, Email [email protected] Zhiqiang Kang, Department of Endocrinology, Affiliated Central Hospital of Zhengzhou University, Zhengzhou, 450000, People’s Republic of China, Email [email protected]: This study was to evaluate the association between triglyceride glucose-body mass index (TyG-BMI) and osteoporosis in patients with type 2 diabetes mellitus (T2DM).Methods: In this cross-sectional study, 892 patients with T2DM hospitalized at Zhengrzhou Central Hospital between April 2024 and March 2025 were included. Participants were grouped into TyG-BMI tertiles (T1 ≤ 209.31, T2 209.31– 243.39, T3 > 243.39). Logistic regression analysis, subgroup and sensitivity analyses, receiver operating characteristic (ROC) curve analysis, and restricted cubic spline (RCS) modeling were performed to evaluate the relationship between TyG-BMI and osteoporosis.Results: After adjusting for potential confounders, each one-unit increase in TyG-BMI was associated with a 1.5% lower odds of osteoporosis (OR = 0.985, 95% CI: 0.978– 0.992). Compared with T1, the odds of osteoporosis were significantly reduced in T2 and T3 (T2: OR = 0.565, 95% CI: 0.352– 0.908; T3: OR = 0.322, 95% CI: 0.167– 0.620). Subgroup analyses confirmed that the inverse association remained stable across most demographic and clinical strata. Sensitivity analyses further supported this trend: participants in the highest TyG-BMI quartile had a 74.8% lower risk of osteoporosis compared with those in the lowest quartile. Individuals with TyG-BMI above the median also showed a markedly reduced osteoporosis risk. ROC analysis showed TyG-BMI had a higher predictive value (AUC = 0.657) for osteoporosis than TyG index (AUC = 0.554) or BMI (AUC = 0.647) alone. RCS analysis indicated a significant linear negative relationship without evidence of nonlinearity (P for nonlinearity = 0.720).Conclusion: Higher TyG-BMI levels are inversely associated with the risk of osteoporosis in patients with T2DM.Keywords: insulin resistance, triglyceride-glucose index, triglyceride glucose-body mass index, osteoporosis, type 2 diabetes mellitus