Dietary advanced glycation end products intake and osteoporosis risk in adults with type 2 diabetes mellitus

Advanced glycation end products (AGEs) derived from dietary sources may aggravate metabolic inflammation and impair bone turnover in patients with type 2 diabetes mellitus (T2DM); however, clinical evidence linking dietary AGEs exposure to osteoporosis (OS) in T2DM remains limited. In this retrospective cohort study, 200 adults with T2DM treated at a tertiary hospital between January 2020 and December 2022 were included. Dietary AGEs intake at baseline was quantified using a simplified food frequency questionnaire complemented by a 3-day dietary record and categorized as high (≥75th percentile), moderate (50th–<75th percentile), or low (<50th percentile). Osteoporosis and osteopenia were defined by dual-energy X-ray absorptiometry T-scores. Inflammatory markers (procalcitonin [PCT], interleukin-6 [IL-6], and C-reactive protein [CRP]) were assessed at baseline and at each patient’s last available follow-up. Logistic regression was performed to identify factors independently associated with OS, and receiver operating characteristic (ROC) curves evaluated predictive performance. The incidence of OS differed across dietary AGEs categories (45.0% high, 23.9% moderate, 18.6% low; P = .013). At the last available follow-up, the low-intake group exhibited lower PCT, IL-6, and CRP levels than the high- and moderate-intake groups (all P < .05). Multivariable analysis identified PCT, β-CTX, P1NP, and dietary AGEs intake as independent factors associated with OS (all P < .05). Dietary AGEs intake showed acceptable discrimination for OS (AUC = 0.797). Higher dietary AGEs intake was associated with a greater likelihood of osteoporosis in adults with T2DM and may contribute through inflammation-related and bone turnover-related pathways.