Visceral Adiposity, Rather than Reduced Appendicular Lean Mass, Characterizes Elderly Hip Fracture Patients with Type 2 Diabetes: A Cross-Sectional DXA Analysis

<b>Background/Objectives:</b> While sarcopenia has been implicated, we hypothesize that a distinct body composition phenotype, characterized by elevated visceral adiposity and reduced abdominal muscle mass, plays a more critical role in T2DM-related fracture pathogenesis. <b>Methods:</b> In a cross-sectional study of 99 female patients aged ≥65 years who underwent surgery for hip fracture, we compared body composition parameters derived from DXA scans between those with (<i>n</i> = 40) and without (<i>n</i> = 59) T2DM. Key measures included appendicular lean mass index (ALMI), visceral adipose tissue (VAT) mass, android-to-gynoid (A/G) fat ratio, and a derived measure of relative core lean mass (RCLM). <b>Results:</b> There were no significant differences in ALMI between T2DM and non-DM groups. In contrast, T2DM showed significantly higher central adiposity-A/G ratio (1.13 ± 0.15 vs. 1.05 ± 0.17; <i>p</i> = 0.0298) and TL fat ratio (1.31 ± 0.22 vs. 1.19 ± 0.23; <i>p</i> = 0.0071)-with VAT estimate numerically higher. <b>Conclusions:</b> In older hip-fracture patients, T2DM was characterized not by appendicular sarcopenia but by central adiposity without significant differences in LMI or RCLM-a phenotype that may contribute to fracture risk through bone-quality and fall-related pathways independent of ALMI.