Background: Type 2 diabetes mellitus (DM) is associated with various complications, including potential effects on bone health. Although elderly patients with Type 2 diabetes mellitus may exhibit normal bone mineral density, they are paradoxically at a higher risk of fractures. The underlying mechanisms remain multifactorial and involve glycemic control, hormonal regulation, and nutrient deficiencies.

Objective: To evaluate bone mineral density (BMD) in elderly patients with type 2 diabetes mellitus and investigate its relationship with glycemic control, vitamin D levels, and calcium status.

Patients and Methods: A prospective, cross-sectional study was conducted on 46 patients aged > 65 years at Merjan Teaching Hospital Babil, Iraq, between May 2024 and May 2025. Data collected included demographics, HbA1c levels, serum vitamin D and calcium levels, and bone mineral density measured via DEXA scans at the spine and hips.

Results: Osteoporosis was present in 54.3% of the patients, and 34.8% of the patients were classified as osteopenic. The majority of the patients were females. A positive correlation was found between HbA1c and DEXA T-scores (r = 0.313, p = 0.034), and patients with poor glycemic control (mean HbA1c = 9.2%) had a higher prevalence of osteoporosis. No significant correlations were found between bone mineral density (Dexa T-scores) and serum vitamin D (r = -0.057, p = 0.705) or calcium levels (r = -0.080, p = 0.597). The right hip had the highest site-specific prevalence of osteoporosis (41.3%).

Conclusions: Osteoporosis is highly prevalent among elderly patients, particularly women. Poor glycemic control (high HbA1c level) and increased age were significantly associated with lower bone density.

Recommendation: DEXA scans of multiple sites, particularly the spine and hips, are essential for detecting osteoporosis in this population.

Word count: 2,654 words, excluding references.

Funding Statement: The study was supported by grant NN from the Foundation of Basic Research. This work was carried out under research program NNN of NN University. Author NN was supported by grant NN from the Ministry of NN.

Ethical Compliance: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Data Access Statement: Research data supporting this publication are available from the NN repository at located at www.NNN.org/download/.

Conflict of Interest declaration: The authors declare that they have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.

Author Contributions: AB and MJ contributed to the design and implementation of the research, JK to the analysis of the results and to the writing of the manuscript. VK conceived the original and supervised the project.

Type 2 diabetes mellitus, Bone mineral density, Osteoporosis, DEXA scan

Vianna AG, Sanches CP, Barreto FC. Effects of type 2 diabetes therapies on bone metabolism. Diabetol Metab Syndr. 2017;9:1.

Murray CE, Coleman CM. Impact of diabetes mellitus on bone health. Int J Mol Sci. 2019;20(19):4873.

Marin C, Luyten FP, Van der Schueren B, Kerckhofs G, Vandamme K. The impact of type 2 diabetes on bone fracture healing. Front Endocrinol (Lausanne). 2018;9:6.

Jiao H, Xiao E, Graves DT. Diabetes and its effect on bone and fracture healing. Curr Osteoporos Rep. 2015;13:327-335.

Jain RK, Vokes T. Dual-energy X-ray absorptiometry. J Clin Densitom. 2017;20(3):291-303.

Picke AK, Campbell G, Napoli N, Hofbauer LC, Rauner M. Update on the impact of type 2 diabetes mellitus on bone metabolism and material properties. Endocr Connect. 2019;8(3):R55-R70.

Kupai K, Kang HL, Pósa A, et al. Bone loss in diabetes mellitus: diaporosis. Int J Mol Sci. 2024;25(13):7269.

Sarodnik C, Bours SP, Schaper NC, Van den Bergh JP, Van Geel TA. The risks of sarcopenia, falls and fractures in patients with type 2 diabetes mellitus. Maturitas. 2018;109:70-77.

Forner P, Sheu A. Bone health in patients with type 2 diabetes. J Endocr Soc. 2024;8(7):bvae112.

Morrison S, Colberg SR, Mariano M, Parson HK, Vinik AI. Balance training reduces falls risk in older individuals with type 2 diabetes. Diabetes Care. 2010;33(4):748-750.

World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO study group. WHO Technical Report Series. 1994;843:1-129.

Sealand R, Razavi C, Adler RA. Diabetes mellitus and osteoporosis. Curr Diab Rep. 2013;13:411-418.

Yuhao S, Cenyi W, Yang G, Guihua X, Yong M. Prevalence of osteoporosis in patients with type 2 diabetes mellitus in the Chinese mainland: a systematic review and meta-analysis. Iran J Public Health. 2019;48(7):1203.

Strotmeyer ES, Cauley JA, Schwartz AV, et al. Diabetes is associated independently of body composition with BMD and bone volume in older white and black men and women: the Health, Aging, and Body Composition Study. J Bone Miner Res. 2004;19(7):1084-1091.

Parizad N, Baghi V, Karimi EB, Gheshlagh RG. The prevalence of osteoporosis among Iranian postmenopausal women with type 2 diabetes: a systematic review and meta-analysis. Diabetes Metab Syndr. 2019;13(4):2607-2612.

Linde J, De Vries F, De Bruin M, Vestergaard P. BMD decreases with increasing HbA1C levels: a cross-sectional study. Osteoporos Int. 2012;23:129.

Gao L, Liu Y, Li M, Wang Y, Zhang W. Based on HbA1c analysis: bone mineral density and osteoporosis risk in postmenopausal female with T2DM. J Clin Densitom. 2024;27(1):101442.

Cândido FG, Bressan J. Vitamin D: link between osteoporosis, obesity, and diabetes? Int J Mol Sci. 2014;15(4):6569-6591.

Rakic V, Davis WA, Chubb SA, Islam FM, Prince RL, Davis TM. Bone mineral density and its determinants in diabetes: the Fremantle Diabetes Study. Diabetologia. 2006;49:863-871.

Liu X, Chen F, Liu L, Zhang Q. Prevalence of osteoporosis in patients with diabetes mellitus: a systematic review and meta-analysis of observational studies. BMC Endocr Disord. 2023;23(1):1.