Chinese Journal of Osteoporosis and Bone Mineral Research · Oct 19, 2026
Correlations of the serum uric acid-to-albumin ratio with bone mineral density and 10-year fracture risk in patients with type 2 diabetes mellitus
By 张馨元
OBJECTIVE: To investigate correlations with bone mineral density (bone mineral density,BMD) and 10-year fracture risk in patients with type 2 diabetes mellitus (type 2 diabetes mellitus,T2DM), stratified by sex and age. METHODS: This retrospective study included 835 patients with confirmed T2DM hospitalized in the Department of Endocrinology at Shandong Provincial Hospital from September 2023 to December 2024. Dual-energy X-ray absorptiometry (dual-energy X-ray absorptiometry,DXA) was used to measure BMD at the femoral neck (femoral neck,FN), total hip (total hip,TH), and lumbar spine (lumbar spine,LS). The fracture risk assessment tool (fracture risk assessment tool,FRAX) was used to assess participants' 10-year risk of major osteoporotic fracture (major osteoporotic fracture,MOF) and 10-year risk of hip fracture (hip fracture,HF). Participants were stratified for research purposes according to T-score: T-score≥-1.0; -2.5＜T-score＜-1.0; and T-score≤-2.5. Participants were divided into Q1～Q4 groups according to quartiles of the serum uric acid-to-albumin ratio (uric acid to albumin ratio,UAR). They were also divided into groups aged ＜60 years and ≥60 years for further stratified analyses. RESULTS: With increasing UAR quartiles, BMD at the FN, TH, and LS showed an increasing trend, whereas FRAX-predicted probabilities of MOF and HF showed a decreasing trend (P≤0.001). In the overall population, UAR was significantly positively correlated with BMD at each site and significantly negatively correlated with fracture risk. Subgroup analyses suggested that these correlations were most pronounced in nonelderly men; women primarily showed positive correlations between UAR and BMD, whereas correlations were weaker in elderly men. Multivariable logistic regression analysis showed that UAR was independently negatively associated with osteoporosis status in patients with T2DM (OR=0.886,95%CI:0.799～0.983,P=0.022). CONCLUSIONS: In patients with T2DM, higher UAR levels were independently associated with higher BMD and lower FRAX-predicted 10-year fracture risk. As a simple biomarker, UAR may help preliminarily predict the risk of abnormal bone mass in patients with T2DM.