Concomitant detection of serum ATF4 levels and MAGE is helpful to predict the occurrence of osteoporosis in patients with type 2 diabetes mellitus.

Background: 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). This retrospective cohort study assessed the predictive value of serum ATF4 and MAGE for the occurrence of OP in T2DM patients.

Methods: A total of 162 patients with T2DM were assigned to T2DM and T2DM + OP groups. All participants underwent serum ATF4 level detection and 72-h 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 the area under the receiver-operating characteristics curve (AUC).

Results: T2DM patients with OP had higher serum ATF4 levels and MAGE than T2DM patients. ATF4 and MAGE were correlated positively with FINS, HbA1c, HOMA-IR, β-CTX, and TRACP-5b and negatively with BALP, PINP, PICP, 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 T2DM patients 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 potentially aids in predicting the occurrence of OP in patients with T2DM.