To explore the relationship of visceral fat with BMD and osteoporotic fracture risk in T2DM patients.

Participants were selected during July to December 2019, including 202 T2DM inpatients from Endocrine Department, Yiyang Central Hospital, and 202 non-diabetics from three towns (Mahekou, Nanzhou, and Maocaojie) and one township (Wuzui) of Nan County, Yiyang, using multistage stratified random sampling. All the assessment examinations were conducted in Yiyang Central Hospital, specifically, BMD at lumbar spine, femoral neck and total hip was measured by dual-energy X-ray absorptiometry, subcutaneous and visceral fat areas were measured by DUALSCAN HDS-2000 visceral fat analyzer (Omron, Japan), and 10-year major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture) or 10-year hip osteoporotic fracture risk was assessed by FRAX questionnaire. T2DM inpatients who completed a FRAX questionnaire in which the item of rheumatoid arthritis was substituted by diabetes, namely, diabetes was considered as a risk factor for osteoporotic fractures, whose assessment results were expressed by FRAX2, otherwise, their assessment results were expressed by FRAX1.

Type 2 diabetic men had higher average weight and BMI, and greater average areas of visceral and subcutaneous fat, and lower average FRAX1 (major osteoporotic fracture) than non-diabetic men (P<0.05). Type 2 diabetic women had greater average age and visceral fat area, lower femoral neck and total hip BMD, and higher average FRAX1 (hip osteoporotic fracture) and FRAX2 (major osteoporotic fracture) and FRAX2 (hip osteoporotic fracture) than non-diabetic women (P<0.05). After adjusting for age and weight, total hip BMD in type 2 diabetic women were lower than those in non-diabetic women (P<0.05). Pearson correlation analysis results showed that visceral fat area was positively correlated with weight, BMI, subcutaneous fat area, BMD at lumbar spine, femoral neck and total hip in non-diabetic men and postmenopausal women (P<0.05). Visceral fat area was positively correlated with weight, BMI, subcutaneous fat area and total hip BMD in non-diabetic women (P<0.05). Visceral fat area was positively correlated with weight, BMI, subcutaneous fat area, lumbar spine BMD and total hip BMD in T2DM men (P<0.05). Visceral fat area was positively correlated with weight, BMI, subcutaneous fat area and total hip BMD in women or postmenopausal women with T2DM (P<0.05). Partial correlation analysis results showed that after adjusting for age and weight, visceral fat area was negatively correlated with femoral neck BMD, and total hip BMD in T2DM women (P<0.05). Visceral fat area was negatively correlated with femoral neck BMD, but positively correlated with FRAX1 (hip osteoporotic fracture) or FRAX2 (hip osteoporotic fracture) in T2DM postmenopausal women (P<0.05) .

T2DM patients had higher weight, BMI and visceral fat area than those without diabetes. T2DM women had lower femoral neck BMD and hip BMD, and may be at higher risk of 10-year hip osteoporotic fracture. Visceral fat area was negatively correlated with femoral neck BMD and total hip BMD in T2DM women. The risk of 10-year hip osteoporotic fracture may increase as visceral fat area increases in postmenopausal women with or without T2DM.