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Association of Triglyceride-Glucose Index with Bone Mineral Density in Non-diabetic Koreans: KNHANES 2008–2011

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Abstract

The association of insulin resistance (IR), as indicated by the homeostasis model assessment of insulin resistance, with bone metabolism is yet to be clarified. We aimed to investigate the relationship of IR with bone mass by using the triglyceride-glucose (TyG) index as an alternative marker of IR. Data of 4810 non-diabetes individuals (2552 men aged ≥ 50 years and 2258 postmenopausal women) from the Korean National Health and Nutritional Examination Survey IV and V were analyzed. Bone mineral density (BMD) at the lumbar spine, femoral neck, total hip, and whole body were measured using dual-energy X-ray absorptiometry. After adjusting for confounding factors, there were inverse relationships of TyG index with femoral neck, total hip, and whole body BMD in men (β =  − 0.085, P < 0.001 at femoral neck; β =  − 0.046, P = 0.037 at total hip; β =  − 0.098, P < 0.001 at whole body). However, in women, femoral neck and whole body BMD were negatively associated with the TyG index (β =  − 0.071, P = 0.008 at femoral neck and β =  − 0.065, P = 0.005 at whole body). The highest TyG index tertile exhibited reduced femoral neck BMD in both sexes (P = 0.003 in men and P = 0.013 in women) and reduced whole body BMD in men (P < 0.001) after adjusting for confounders. When the study subjects were divided into BMI (body mass index) < 23 kg/m2 and ≥ 23 kg/m2 groups, the TyG index was significantly associated with femoral neck BMD only in the women with BMI < 23 kg/m2 (P = 0.009). We observed a significant association between the highest TyG index tertile and low bone mass at the femoral neck in women with BMI < 23 kg/m2 (P = 0.003) that was not observed in women with BMI ≥ 23 kg/m2 and men. In conclusion, IR evaluated using the TyG index was inversely associated with femoral neck BMD in non-diabetic men aged ≥ 50 years and postmenopausal women. The negative influence of IR on femoral neck BMD was robust in the women with BMI < 23 kg/m2. This indicates a differential effect of IR on BMD according to skeletal site, sex, and BMI.

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Authors and Affiliations

  1. Department of Internal Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, Republic of Korea

    Jee Hee Yoon, A Ram Hong, Wonsuk Choi, Ji Yong Park, Hee Kyung Kim & Ho-Cheol Kang

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Correspondence to A Ram Hong.

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Conflict of interest

Jee Hee Yoon, A Ram Hong, Wonsuk Choi, Ji Yong Park, Hee Kyung Kim, and Ho-Cheol Kang declare that they have no conflicts of interest.

Human and Animal Rights

The KNHANES surveys were reviewed and approved by the Institutional Review Board of the Korea Center for Disease Control and Prevention (IRB Nos. 2008-04EXP-01-C, 2009-01CON-03-2C, 2010-02CON-21, and 2011-02CON06-C).

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Written informed consents were obtained from all participants prior to survey enrollment. The study was conducted in accordance with the Declaration of Helsinki.

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223_2020_761_MOESM1_ESM.tif

Supplementary file 1 Supplementary Fig. 1. BMD values according to TyG index tertile and BMI in men (A) and women (B) after adjusting for confounders including age, serum 25-hydroxyvitamin D, physical activity, current smoking, and alcohol drinking status. aP < 0.05 vs. the highest tertile (T3) and BMI < 23 kg/m2 by ANCONA (TIF 536 kb)

Supplementary file 2 (DOCX 17 kb)

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Yoon, J.H., Hong, A.R., Choi, W. et al. Association of Triglyceride-Glucose Index with Bone Mineral Density in Non-diabetic Koreans: KNHANES 2008–2011. Calcif Tissue Int 108, 176–187 (2021). https://doi.org/10.1007/s00223-020-00761-9

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