The association between sex hormones and osteocalcin levels with bone parameters in male prediabetic patients

Objectives Prediabetes is a prevalent metabolic disorder. The potential impact of a bone-pancreas-testis axis on bone density in males with prediabetes is a topic of interest. This study compares bone parameters in prediabetic males with a control group and explores the relationship between sex hormones, metabolic changes, and bone density. Methods In this case-control study, 65 prediabetic males and 66 age- and body mass index (BMI)-matched healthy controls were included. Blood samples were collected to measure serum levels of insulin, osteocalcin, interleukin 6 (IL), C-reactive protein, follicle-stimulating hormone, luteinizing hormone, total testosterone, and dehydroepiandrosterone sulfate. Bone density at the lumbar vertebrae, neck of the left femur, total hip, and lumbar spine trabecular bone score (LS TBS) were assessed using dual-energy X-ray absorptiometry. Results Prediabetic males had lower testosterone (p = 0.030) and osteocalcin (p = 0.009) levels. However, there was no significant relationship between total testosterone and insulin levels or the homeostasis model assessment-estimated insulin resistance (HOMA-IR) index. Both groups had similar bone parameters, with BMI significantly influencing bone density at all skeletal sites in the prediabetes group. The prediabetes group had lower LS TBS compared to normoglycemic males, and a negative correlation was found between IL-6 and LS TBS in prediabetic males. Conclusion Despite lower levels of testosterone and osteocalcin in prediabetic males, their bone density was similar to that of the controls, but prediabetic males had lower TBS values. Therefore, the quality of bone microarchitecture in prediabetic males may not be superior to that of their normoglycemic counterparts, and low-grade inflammation may play a role in the discrepancy between bone mineral density and trabecular bone score in prediabetic individuals. However, the potential influence of sex hormones and metabolic abnormalities on bone density or quality in prediabetic males is still uncertain and warrants further research.