A Cross-Sectional Study on the correlation between fasting blood glucose and bone turnover markers in Chinese patients with osteoporotic fractures

Meng-cheng Zhu ^1,2 Min-zhe Xu ^1,2 Chang-xuan Li ^2,3 Jia-hao Wang ^2,3 Chong Li ^1,2 Ya-qin Gong ^2,4 Jian Jin ⁵ Ke Lu ^1,2* Yan-ming Hao ^1,2*

• ¹ Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
• ² Kunshan Biomedical Big Data Innovation Application Laboratory, Suzhou, Jiangsu, China
• ³ Department of Orthopedics, The First People's Hospital of Kunshan, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
• ⁴ Information Department, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
• ⁵ Kunshan municipal Health and Family Planning Information Center, Suzhou, Jiangsu, China

Background: Recent studies suggest that metabolic factors, such as fasting blood glucose (FBG), may significantly affect bone health, influencing the risk and severity of osteoporotic fractures (OPFs). This study examined the association between FBG levels and bone turnover markers (BTMs) in patients hospitalized for OPFs requiring surgical intervention.: A retrospective cross-sectional analysis was conducted on 888 patients treated for OPFs at Kunshan Hospital affiliated with Jiangsu University from November 2018 to August 2023. Serum levels of FBG, procollagen type 1 N-terminal propeptide (P1NP), and β-C-terminal telopeptide of type I collagen (β-CTX) were measured, with FBG serving as an independent variable, and P1NP and β-CTX as outcome variables. Patients were stratified into tertiles based on FBG levels, and multiple regression models were adjusted for confounding variables, including age, gender, BMI, and clinical parameters. Non-linear relationships and threshold effects were analyzed.Results: Adjusted regression models identified a negative association between FBG and BTMs. For each 1 mmol/L increase in FBG, β-CTX levels decreased by 0.02 ng/mL (95% CI: -0.04 to -0.01; P < 0.01), and P1NP levels decreased by 2.91 ng/mL (95% CI: -4.38 to -1.45; P < 0.01). Non-linear relationships were observed, with an inflection point at 7.93 mmol/L for both markers. Below this threshold, higher FBG levels were associated with a steeper decline in BTMs.FBG levels exhibit a negative non-linear association with P1NP and β-CTX in patients with OPFs. Elevated FBG levels may adversely affect BTMs, potentially contributing to the progression of osteoporosis (OP). These findings underscore the importance of glycemic control in managing bone health among patients with OPFs.