Abstract

Background and Objectives: Uric acid to high-density lipoprotein cholesterol ratio (UHR) plays a significant role in metabolic and inflammatory responses. However, the association between UHR and osteoporosis (OP) remains unclear in type 2 diabetes mellitus (T2DM) with metabolic dysfunction-associated steatotic liver disease (MASLD). This study aims to investigate this association and identify potential biomarkers for early OP screening. Methods and Study Design: A total of 420 T2DM patients with MASLD aged ≥50 years were enrolled in this retrospective study. All subjects underwent dual energy X-ray absorptiometry (DXA) examination to measure bone mineral density (BMD) and were divided into three groups according to UHR tertiles, and the differences in BMD levels and OP prevalence among the three groups were compared. Logistic regression was used to analyze the relationship between UHR and OP. Results: Patients in the highest tertile of UHR group (UHR >363.46) had lower BMD and a higher incidence of OP than those in the lower tertiles. In the UHR >363.46 group, UHR was negatively correlated with lumbar spine, whole body, and femoral neck BMD (p <0.05). After adjusting for confounding factors, UHR >363.46 was associated with a significantly increased risk of OP compared to UHR ≤312.35 (OR = 3.341, 95%CI: 1.129-9.887, p = 0.029). ROC curve indicated that UHR combined with Age, HOMA-IR and 25(OH)D had a high predictive value for OP, with an area under the curve of 0.837 (p <0.001). Conclusions: Increased UHR is significantly associated with higher risk of OP, suggesting that clinical monitoring of UHR is valuable for early detection of OP in T2DM with MASLD.

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