Visceral Adiposity, Rather than Reduced Appendicular Lean Mass, Characterizes Elderly Hip Fracture Patients with Type 2 Diabetes: A Cross-Sectional DXA Analysis

TL;DR

This study finds that type 2 diabetes in elderly hip fracture patients is linked to central fat rather than muscle loss.

Contribution

The study identifies central adiposity, not sarcopenia, as a key body composition feature in T2DM-related hip fractures.

Findings

T2DM patients had higher android-to-gynoid fat ratios compared to non-diabetic patients.

Visceral adipose tissue was numerically higher in T2DM patients.

Appendicular lean mass index did not differ significantly between T2DM and non-DM groups.

Abstract

Background/Objectives: While sarcopenia has been implicated, we hypothesize that a distinct body composition phenotype, characterized by elevated visceral adiposity and reduced abdominal muscle mass, plays a more critical role in T2DM-related fracture pathogenesis. Methods: In a cross-sectional study of 99 female patients aged ≥65 years who underwent surgery for hip fracture, we compared body composition parameters derived from DXA scans between those with (n = 40) and without (n = 59) T2DM. Key measures included appendicular lean mass index (ALMI), visceral adipose tissue (VAT) mass, android-to-gynoid (A/G) fat ratio, and a derived measure of relative core lean mass (RCLM). Results: There were no significant differences in ALMI between T2DM and non-DM groups. In contrast, T2DM showed significantly higher central adiposity—A/G ratio (1.13 ± 0.15 vs. 1.05 ± 0.17; p = 0.0298) and TL fat ratio (1.31 ± 0.22 vs. 1.19 ± 0.23; p = 0.0071)—with VAT estimate numerically higher. Conclusions: In older hip-fracture patients, T2DM was characterized not by appendicular sarcopenia but by central adiposity without significant differences in LMI or RCLM—a phenotype that may contribute to fracture risk through bone-quality and fall-related pathways independent of ALMI.

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