Objective:

To investigate the association between neutrophil percentage-to-albumin ratio (NPAR) and bone mineral density (BMD), as well as prevalent osteoporosis, in patients with type 2 diabetes mellitus (T2DM).

Approach:

• Study Design: A retrospective cross-sectional study including 259 patients with T2DM, assessing osteoporosis via WHO criteria and BMD through dual-energy X-ray absorptiometry.
• Statistical Analysis: Logistic regression for osteoporosis association, linear regression for BMD relationship, and receiver operating characteristic analysis for discriminative capacity.

Key Findings:

• NPAR levels were higher in the osteoporosis group (P = 0.004).
• NPAR was independently associated with osteoporosis (OR = 3.42, 95% CI: 1.10-10.64, P = 0.034).
• NPAR was negatively associated with femoral neck BMD (b = -0.08, 95% CI: -0.14 to -0.02, P = 0.009) and total hip BMD (b = -0.08, 95% CI: -0.14 to -0.01, P = 0.020).
• The AUC for NPAR's discriminative capacity for osteoporosis was 0.62 (95% CI: 0.54-0.71, P = 0.004).

Interpretation:

NPAR may provide supplementary information regarding prevalent osteoporosis in patients with T2DM, but should not be used as an independent screening marker.

Limitations:

• Retrospective design may introduce bias.
• Single-center study limits generalizability.
• NPAR's modest discriminative ability suggests it should be used alongside other clinical indicators.

Conclusion:

NPAR is associated with osteoporosis and BMD in T2DM patients, but its clinical utility is limited without consideration of additional factors.