Glycated hemoglobin and bone mineral density in adults with and without type 2 diabetes: a cross-sectional DXA study from the Qassim region, Saudi Arabia

This comparative cross-sectional study evaluated bone mineral density (BMD) and its association with glycemic control and biochemical bone markers among adults with and without type 2 diabetes mellitus (T2DM) in the Qassim region, Saudi Arabia. A comparative cross-sectional study was conducted among 73 adults (comprising individuals with T2DM and non-diabetic controls) recruited from healthcare facilities in the Qassim region, Saudi Arabia. Clinical, demographic, and bone health data were collected using a structured questionnaire and hospital medical records. Glycated hemoglobin (HbA1c), serum calcium, alkaline phosphatase (ALP), fracture history, and bone mineral density were evaluated. BMD was measured at the lumbar spine and femoral neck using dual-energy X-ray absorptiometry (DXA) and classified according to the World Health Organization (WHO) criteria. Statistical analyses were performed using SPSS version 23.0. T2DM was diagnosed in 69.9% of participants; 48.0% had osteopenia and 19.2% had osteoporosis. Chronological age was associated with progressive bone mineral density loss across successive cohorts ( Pearson χ² = 11.14, p = 0.025). Among participants with T2DM, mean HbA1c increased progressively with longer diabetes duration (Spearman’s rho = 0.310, p = 0.027). In an exploratory multinomial logistic regression model, higher HbA1c was associated with lower bone mineral density categories each 1% increase in HbA1c was associated with higher odds of osteopenia (adjusted odds ratio [aOR] = 2.34, 95% confidence interval [CI]: 1.12–4.88; p = 0.024) and osteoporosis (aOR = 3.89, 95% CI: 1.45–10.42; p = 0.007). Serum calcium and alkaline phosphatase (ALP) were not significantly associated with bone mineral density. Low bone mineral density was common in this study population. Higher HbA1c levels were associated with lower bone mineral density categories in an exploratory regression model adjusted for the variables included in the analysis. These findings support further investigation of the relationship between glycaemic control and bone health in larger prospective studies with comprehensive adjustment for clinical confounders.