Concomitant Detection of Serum Activating Transcription Factor 4 Levels and Mean Amplitude of Glycemic Excursion Is Helpful to Predict Osteoporosis in Adult Patients With Type 2 Diabetes Mellitus.

Objectives: Activating transcription factor 4 (ATF4) and mean amplitude of glycemic excursion (MAGE) have been implicated in the pathogenesis of osteoporosis (OP) and type 2 diabetes mellitus (T2DM). In this retrospective cohort study we assessed the predictive value of serum ATF4 and MAGE for occurrence of OP in patients with T2DM.

Methods: A total of 162 patients with T2DM were assigned to T2DM or T2DM+OP groups. All participants underwent serum ATF4 level detection and 72-hour blood glucose monitoring (MAGE measurement). The correlations of ATF4 and MAGE with glucose and bone metabolism indicators and bone mineral density (BMD) were analyzed. A multivariate logistic regression model was developed to evaluate the correlations of ATF4 and MAGE with T2DM-associated OP. The diagnostic performance of concomitant detection of ATF4 and MAGE was assessed based on area under the receiver-operating characteristic (AUC) curve.

Results: Patients with T2DM with OP had higher serum ATF4 levels and MAGE than patients with T2DM only. ATF4 and MAGE correlated positively with fasting insulin, glycated hemoglobin, homeostatic model for insulin resistance assessment, beta-C-terminal crosslinking telopeptide of type I collagen, and tartrate-resistant acid phosphatase-5b, but negatively with bone alkaline phosphatase, serum procollagen type I N-propeptide, procollagen type I carboxy-terminal propeptide, and BMD. Elevated levels of ATF4 and MAGE were independent risk factors, but increased BMD at the hip, femoral neck, and lumbar spine was a protective factor for patients with T2DM with OP. More importantly, the AUC of concomitant ATF4 and MAGE was considerably higher than that of ATF4 or MAGE alone.

Conclusion: Concomitant detection of ATF4 and MAGE may aid in predicting the occurrence of OP in patients with T2DM.