Abstract:

Objective To investigate the predictive value of microRNA （miR）-155， miR-31-5p， Asprosin， and glycogen synthase kinase-3β （GSK-3β） levels in the development of osteoporosis （OP） in patients with type 2 diabetes mellitus （T2DM）. Methods A total of 158 patients diagnosed with T2DM and admitted to Shijiazhuang People's Hospital between March 2024 and October 2025 were selected as the research subjects. These patients were grouped according to the presence or absence of OP， which was determined based on the T-values from bone mineral density measurements. Patients with T-values ≤ -2.5 were classified into the T2DM-OP group （54 cases）， while the remaining patients were classified into the T2DM non-OP group （104 cases）. Multivariate factors associated with T2DM-OP were analyzed. Receiver operating characteristic （ROC） analysis was performed to assess the diagnostic efficacy of age， glycated hemoglobin （HbA_1C）， disease duration， smoking， drinking， miR-155， miR-31-5p， asprosin， and GSK-3β levels for T2DM-OP. Spearman correlation analysis was employed to explore the correlation between miR-155， miR-31-5p， asprosin， and GSK-3β levels and bone mineral density. Results The T2DM-OP group exhibited higher levels of age， HbA_1C， disease duration， miR-155， Asprosin， and GSK-3β when compared to the T2DM non-OP group. In contrast， the level of miR-31-5p in the T2DM-OP group was lower than that in the T2DM non-OP group. Moreover， the proportions of smoking and drinking were also higher in the T2DM-OP group than in the T2DM non-OP group （P < 0.05）. Age， HbA_1C， disease duration， smoking， drinking， miR-155， miR-31-5p， Asprosin， and GSK-3β were all identified as independent risk factors for T2DM complicated with OP （OR = 1.950， 1.876， 2.111， 2.008， 1.908， 2.002， 2.016， 1.793， 1.956， P < 0.05）. The combined detection of age， HbA_1C， disease duration， smoking， drinking， miR-155， miR-31-5p， Asprosin， and GSK-3β yielded an AUC value of 0.899 （95%CI： 0.848 - 0.949） for T2DM complicated with OP. The AUC values of each indicator detected individually were 0.805， 0.778， 0.829， 0.657， 0.651， 0.776， 0.759， 0.803， and 0.788 respectively. The AUC value of the combined detection was significantly higher than those of the individual detections （P < 0.05）. The sensitivity of the combined detection was 81.50% and the specificity was 86.50%. The levels of miR-155， Asprosin， and GSK-3β were negatively correlated with bone density （r = -0.612， -0.596， -0.604， P < 0.05）， whereas the level of miR-31-5p was positively correlated with bone density （r = 0.527， P < 0.05）. Conclusions Age， HbA_1C， disease duration， smoking， drinking， miR-155， miR-31-5p， Asprosin， and GSK-3β levels are all associated with T2DM complicated with OP. The combined detection of these indicators has a higher diagnostic efficacy than the individual detection of each indicator， and it is expected to provide new ideas for the early identification and prevention of high-risk patients.

Key words: type 2 diabetes, osteoporosis, microRNA-155, microRNA-31-5p, Asprosin, glycogen synthase kinase-3β, diagnostic value