Serum Osteocalcin as a Risk Factor for osteosarcopenia in elderly patients with T2DM

Serum Osteocalcin as a Risk Factor for osteosarcopenia in elderly patients with T2DM | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Serum Osteocalcin as a Risk Factor for osteosarcopenia in elderly patients with T2DM Junyan Li, Qinqin Si, chuyue yuan, Na Li, Niuniu Yuan, Huimin Shen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3940392/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Osteosarcopenia(OS) has become a global public health problem, which highly influence the life quality for the elderly patients with type 2 diabetes mellitus (T2DM). However, the diagnostic processes is complex and difficult due to lack of the exact diagnostic biomarker. Thus, it is necessary to screen the sensitive biomarker of musculoskeletal metabolism in older patient with T2DM. Previous studies have suggested that osteocalcin mainly involved into the development of musculoskeletal metabolism. This study aimed to investigate the relationship between osteocalcin and osteosarcopenia in elderly patients with T2DM. Methods Here we designed a cross-sectional study that included 224 elderly patients with T2DM. We collected the general data and experimental indexes of those patients including bone mineral density (BMD), skeletal muscle index (SMI), grip strength, and gait speed were measured. All subjects were divided into 5 groups based on the above indicators: Controls (CO), Pre-osteosarcopenia(P-OS),Sarcopenia (SP), Osteoporosis(OP), Osteosarcopenia (OS).Meanwhile we examined several bone metabolism-related indexes such as osteocalcin (OC), β-collagen special sequence (β-CTX), and type I procollagen N-terminal propeptide (PINP). Logistic regression analysis was used to analyze the relationship between osteoscarsopenia and osteocalcin. Results The results showed the levels of OC, β-CTX, and PINP increased in the osteosarcopenia group. BMD, SMI, handgrip strength and calf circumference decreased with the increasing osteocalcin concentrations (p < 0.05). A higher serum osteocalcin level was associated with higher risk of OS (OR = 10.84, 95% CI (1.24-95.00)) in the logistic regression model. Conclusion Osteocalcin might be used as the important biomarker to predict the risk of OS in elderly type 2 diabetes. T2DM osteocalcin osteoporosis sarcopenia osteosarcopenia 1. Introduction Sarcopenia and osteoporosis seriously threaten the health of elderly patients with type 2 diabetes (T2DM). Those two diseases have overlapping in genetic background, physiology, and pathology and frequently present in the form of comorbidities. In 2019, the concept of osteosarcopenia (OS) was proposed for this comorbidities disease [ 1 ]. Subsequently, it was found that the occurrence of osteosarcopenia was significantly increased in elderly patients with T2DM [ 2 ]. So early diagnostic of osteosarcopenia is necessary elderly patients with T2DM to improve the prognosis, treatment, and life quality of patients. Currently, the diagnostic procedure for osteosarcopenia is relatively complex and lacks sensitive biomarkers. Muscle-skeleton crosstalk provides novel insights into the pathogenesis of the comorbidity. We focused on musculoskeletal crosstalk and investigated the relationship between bone metabolism markers and muscle tissue metabolism, in order to screen out the effective biomarkers and therapeutic targets of osteosarcopenia. Osteocalcin (OC) as a cytokine released by osteoblasts mediated into in the important processes including bone metabolism, glycolipid metabolism, and cognition and emotion improvement, exercise modulation [ 3 ]). In recent animal studies, it was found that OC induced myoblast proliferation and differentiation, promoted muscle protein synthesis, increased muscle content and muscle fiber strength [ 4 , 5 ], and improved muscle endurance, muscle metabolism and function [ 6 , 7 ].At present, the relationship between OC and osteosarcopenia remains unknown. Therefore, the purpose of this study is to explore the correlation between osteocalcin and osteosarcopenia in elderly patients with T2DM, to find an effective biomarker for osteosarcopenia in the elderly patients with T2DM which provided a theoretical basis for early clinical intervention. 2. Materials and Methods 2.1 Participants T2DM patients with an age greater than 60 years were consecutively recruited from the inpatient population of the Department of Endocrinology at Heji Hospital, affiliated with Changzhi Medical College, between September 2021 and September 2023. All participants provided written informed consent before inclusion in the study. And the study was approved by the ethics committee of Changzhi Medical College Affiliated Heji Hospital. The exclusion criteria were as follows: 1) patients with type 1 diabetes mellitus or other specific types of diabetes; 2) patients with long-term nutritional deficiency, low calcium, a history of heavy smoking, long-term bed rest, a tumor, a mental illness, cognitive communication impairment, or mobility difficulties who cannot cooperate with the examination; 3) patients who have devices in the body such as pacemakers or metal stents that affect the analysis of body composition; 4) patients who have used drugs that can affect bone metabolism (such as glucocorticoids, antiepileptic drugs, bisphosphonates, etc.; 5) patients with hyperthyroidism, hyperparathyroidism, Cushing’s syndrome, rheumatoid arthritis, and abnormal liver and kidney function 2.2 Groups of osteosarcopenia The diagnostic criteria for sacopenia refer to the consensus that was published by the Asian Sarcopenia Working Group (AWGS) in 2019, which defined sarcopenia as low muscle mass, decreased muscle strength, and/or decreased physical function. Low muscle mass was defined using the SMI; the cutoff value was 7.0 kg/m2 in men and 5.4 kg/m2 in women. Decreased muscle strength was defined as grip strength below 18kg for females and below 28kg for males. Decreased physical function was defined as walking speed ≤ 1.0 m/s. In order to diagnose sarcopenia, either ①+② or ①+③ must be fulfilled, and severe sarcopenia was defined as ①+②+③. The diagnosis of osteoporosis was based on the World Health Organization’s (WHO) classification system: T-scores ≤ -2.5 SD indicate osteoporosis; those between − 2.5 SD and − 1.0 SD indicate osteopenia; and T-scores ≥ -1.0 SD indicate normal bone density. According to the above diagnostic criteria, all enrolled elderly T2DM patients were divided into the following five groups: (1) Group Controls (CO): normal BMD and SMI; (2) Group Pre-osteosarcopenia: osteopenia with or without low muscle mass; (3) Group Sarcopenia (SP): sarcopenia without osteoporosis; (4) Group Osteoporosis (OP): osteoporosis without sarcopenia; (5) Group Osteosarcopenia (OS): osteoporosis + sarcopenia. 2.3 Clinical features collection We collected demographic information, including age, duration of diabetes, age of menopause, marriage and childbearing history, smoking and drinking history, SARC-F questionnaire scoring scale, medications, complications, and concomitant diseases, etc. Meanwhile we measured height, weight, and body mass index (BMI) of each subject. 2.4 Biochemical Measurements Blood samples were extracted from each patient in the morning for biochemical tests. General biochemical indicators such as liver and kidney function, glycated Haemoglobin (HbA1c), blood lipids, and so on were performed with standard methods. We also tested some bone metabolism markers, including osteocalcin (OC), procollagen type I N-prepeptide (PINP), β-Cross Laps (β-CTX), and parathyroid hormone (PTH), with an electrochemical luminescence immunoassay kit (Roche, Germany) 2.5 Handgrip strength and calf circumference We measured the maximal handgrip strength of the dominant hand with a hand-held dynamometer (Jamar, USA). At the process of measurement, the participants should seat, keep shoulder adduction, make elbow flex at 90°, and forearm in a neutral position. The participants should squeeze the device as forcefully as possible, and the highest scores among three tests were recorded. We also measured the calf circumference (CC) of both legs when the patient seated with knee flexion of 90°, and relaxed with foot and ankle joints.. 2.6 The walking speed of 6 meters In order to record the walking speed of the subject (6 m), we record the time of 6-meterswalking at the normal walking speed. We tested three times, and recorded the fastest speed. 2.7 DXA measurement We evaluated the lumbar spine (L1–L4) and left hip BMD (g/cm 2 ) with a dual-energy X-ray absorptiometry (DXA) scanner (QDR Discovery, MA, USA). And the left hip evaluation included the femoral neck, trochanter, and shaft, as well as the total femur. The least significant changes (LSCs) of the lumbar spine and femoral neck were 0.021 g/cm2 and 0.030 g/cm2, respectively. We also assess the whole-body composition including skeletal muscle mass and fat mass. Skeletal muscle index (SMI) was calculated as the sum of the lean mass of both arms and legs and was divided by squared body height (kg/m 2 ). 2.8 Statistical Analysis All data were statistically analyzed using SPSS 26.0 (SPSS Inc., Chicago, IL, United States). For continuous variables, normality tests were performed using the Kolmogorov-Smirnov test. The measurement data conforming to a normal distribution were expressed as mean ± standard deviation (x ± s), and ANVOA analysis was used to compare groups. Those data that did not conform to the normal distribution were expressed by the quartile [M (P25, P75)], and the comparison between groups was tested by the Kruskal-Wallis H test. The enumeration data were expressed in percentages, and a chi-square test was used for comparison between groups. Logistic regression analysis was used to analyze the relationship between osteoscarsopenia and osteocalcin. P < 0.05 was considered to be statistically significant for all tests. 3. Results 3.1 Comparison of general characteristics and musculoskeletal indicates of elderly patients with T2DM A total of 224 patients over 60 years old were included in this study (age: 60–85 years, BMI: 14.12–34.10 kg/m 2 , and disease duration range: 0.1–30 years), who were then divided into five groups, including 119 females and 105 males, of whom 15.6% were OS. Compared with the Group CO, the patients in Group OS were relatively elder and had a lower BMI index (P < 0.05); there was no significant difference in complications of diabetes and hypertension among all groups (Table 1). Tabel 1 Comparison of general clinical characteristics among five groups CO (n = 37) P-OS (n = 64) SP (n = 39) OP (n = 49) OS (n = 35) F/χ 2 χ 2 P -value Female,n(%) 20(54.1) 24 (34.8) a 19(48.7) 37(75.5) abc 24(68.6) bc 24.498 < 0.001 Age(years) 65.5 ± 2.6 68.0 ± 5.9 a 70.2 ± 6.6 a 68.6 ± 5.8 a 71.1 ± 6.3 ab 11.150 < 0.001 Duration of diabetes(years) 9.7 ± 7.3 12.1 ± 7.8 13.2 ± 7.0 10.0 ± 6.8 13.1 ± 8.1 1.947 0.104 BMI(kg/cm 2 ) 24.9 ± 2.8 25.3 ± 3.0 25.2 ± 3.4 24.9 ± 2.6 22.4 ± 3.1 abcd 6.522 < 0.001 Hypertension,n(%) 19(51.4) 46(66.7) 21(61.8) 25(51.0) 22(62.9) 4.183 0.382 Diabetic nephropathy,n(%) 5(13.5) 15(21.7) 9(26.5) 5(10.2) 11(31.4) 7.762 0.101 Diabetic retinopathy,n(%) 6(16.2) 21(30.4) 6(17.6) 9(18.4) 5(14.3) 5.602 0.231 Diabetic peripheral vasculopathy,n(%) 7(87.5) 61(88.4) 28(82.4) 44(89.8) 28(80.0) 2.373 0.667 Diabetic peripheral neuropathy,n(%) 17(45.9) 48(69.6) 21(61.8) 29(59.2) 24(68.6) 6.534 0.163 Data are presented as mean ± SD or number (%); OS :osteoporosis with sarcopenia; P-OS :osteopenia with/ without low SMI; SP : sarcopenia without osteoporosis; OP : osteoporosis without sarcopenia; CO : normal BMD and SMI. a indicates significant difference (p < 0.05) to CO; b indicates significant difference (p < 0.05) to P-OS; c indicates significant difference (p < 0.05) to SP; d indicates significant difference (p < 0.05) to OP. There were no significant differences in the levels of HbA1c, ALB, ALT, AST, TG, TC, LDL-C, and HDL-C among all groups, except for ALP, CRE, and UA (P < 0.05) (Table 2 ). Table 2 Comparison of routine biochemical indexes among five groups Characteristics CO (n = 37) P-OS (n = 64) SP (n = 39) OP (n = 49) OS (n = 35) F value P value HbA1c(%) 8.43 ± 2.17 8.74 ± 2.24 8.53 ± 1.96 8.98 ± 1.73 9.14 ± 2.52 0.729 0.573 TP(g/L) 71.00 ± 6.63 70.28 ± 6.82 71.44 ± 2.45 71.63 ± 4.16 72.91 ± 4.96 1.515 0.199 ALB(g/L) 41.38 ± 5.68 42.17 ± 3.86 42.29 ± 2.95 42.37 ± 2.68 41.63 ± 2.81 0.380 0.823 ALT(U/L) 22.78 ± 16.98 21.65 ± 12.97 21.53 ± 13.42 28.84 ± 28.11 19.09 ± 17.28 1.730 0.144 AST(U/L) 22.25 ± 9.93 21.30 ± 7.86 20.97 ± 7.84 26.47 ± 14.20 21.69 ± 11.40 2.226 0.067 ALP(U/L) 84.61 ± 24.33 77.58 ± 21.99 73.59 ± 15.97 94.82 ± 34.52 bc 93.20 ± 24.93 bc 5.895 < 0.001 TCH(mmol/L) 4.41 ± 1.01 4.46 ± 1.22 3.99 ± 1.10 4.43 ± 1.05 4.69 ± 1.08 1.791 0.132 TG(mmol/L) 1.86 ± 0.89 1.72 ± 1.16 1.62 ± 1.16 1.59 ± 0.73 1.63 ± 0.69 0.530 0.714 HDL-C(mmol/L) 1.08 ± 0.28 1.06 ± 0.24 1.06 ± 0.24 1.06 ± 0.24 1.17 ± 0.38 1.212 0.306 LDL-C(mmol/L) 2.54 ± 0.87 2.75 ± 0.85 2.47 ± 0.75 2.78 ± 0.87 2.91 ± 0.82 1.712 0.148 BUN(mmol/L) 6.63 ± 1.77 5.61 ± 1.55 5.41 ± 1.71 5.53 ± 1.21 5.89 ± 2.04 1.186 0.318 CRE(µmol/L) 60.00 ± 19.71 70.71 ± 18.73 a 68.29 ± 15.57 61.37 ± 13.01 b 70.09 ± 23.77 ad 3.323 0.012 UA(µmol/L) 278.75 ± 104.40 318.54 ± 93.64 a 286.29 ± 67.57 288.80 ± 93.19 265.51 ± 64.73 b 2.617 0.036 Ca(mmol/L) 2.00 ± 0.00 2.01 ± 0.12 2.03 ± 0.17 2.04 ± 0.20 2.06 ± 0.24 0.752 0.558 P(mmol/L) 1.00 ± 0.00 1.03 ± 0.17 1.00 ± 0.00 1.04 ± 0.20 1.06 ± 0.24 0.888 0.472 Data are presented as mean ± SD.HbA1c: glycosylated hemoglobin;TP:total protein;ALB:albumin;ALT:alanine aminotransferase;AST:aspartate aminotransferase;ALP:alkaline phosphatase; TCH : total cholesterol; TG:triglyceride;HDL-C:high density lipoprotein cholesterin;LDL-C:low density lipoprotein cholesterin;BUN:blood urea nitrogen;CRE:creatinine;UA:Uric Acid; a means compared with CO; b means compared with P-OS; c means compared with SP; d means compared with OP. The levels of OC, β-CTX, and PINP in the OS group significantly increased (P < 0.05), and the waist-hip ratio, SARC-F scale score, calf circumference, SMI, BMD, and grip strength significantly decreased compared to the other groups ( Table 3 ). Table 3 Comparison of musculoskeletal indicates among five groups Characteristics CO (n = 37) P-OS (n = 64) SP (n = 39) OP (n = 49) OS (n = 35) F/H P -value Calf circumference(cm) 35.01 ± 2.47 35.25 ± 2.13 34.42 ± 2.68 33.61 ± 3.38 ab 31.77 ± 3.24 abcd 10.668 < 0.001 Handgrip strength (kg) 26.42 ± 9.94 24.79 ± 9.56 23.90 ± 8.84 a 24.41 ± 7.82 a 21.71 ± 9.38 a 3.656 0.007 6m walking speed(m/s) 1.02 ± 0.27 1.02 ± 0.22 0.89 ± 0.20 ab 1.01 ± 0.23 c 0.86 ± 0.20 abd 4.975 < 0.001 Total body fat percentage(%) 34.63 ± 6.01 33.05 ± 5.99 34.22 ± 7.15 35.49 ± 6.54 34.31 ± 8.03 1.015 0.401 Waist-Hip ratio 1.02 ± 0.10 1.21 ± 0.21 a 1.20 ± 0.19 a 1.20 ± 0.17 a 1.10 ± 0.18 bcd 8.468 < 0.001 SMI(g/cm 2 ) 6.33 ± 0.84 6.28 ± 0.77 5.73 ± 0.76 ab 5.96 ± 0.89 ab 5.31 ± 0.83 abcd 10.680 < 0.001 BMD(g/cm 2 ) Lumbar spine Total left hip Left femoral neck 1.01 ± 0.05 0.96 ± 0.19 1.02 ± 0.16 0.79 ± 0.14 abc 0.81 ± 0.18 abc 20.571 < 0.001 0.96 ± 0.08 0.72 ± 0.09 a 0.76 ± 0.10 a 0.58 ± 0.09 abc 0.55 ± 0.17 abc 91.944 < 0.001 1.00 ± 0.03 0.91 ± 0.11 a 0.93 ± 0.15 a 0.75 ± 0.11 abc 0.73 ± 0.13 abc 44.536 < 0.001 OC(ng/mL) 13.01 ± 3.19 15.27 ± 6.34 14.50 ± 4.81 16.49 ± 5.63 a 20.13 ± 7.66 abcd 7.748 < 0.001 PINP(ng/mL) 40.11 ± 11.06 37.33 ± 12.91 38.50 ± 10.09 46.10 ± 16.68 abc 45.77 ± 14.55 bc 4.465 0.002 β-CTX(ng/mL) 0.31 ± 0.42 0.39 ± 0.17 0.39 ± 0.17 0.45 ± 0.16 a 0.48 ± 0.28 a 2.876 0.024 PTH(pg/mL) 45.30 ± 12.74 49.02 ± 21.73 46.69 ± 14.04 50.12 ± 26.00 49.58 ± 23.73 25.558 < 0.001 SARC-F, median (Q1, Q3) 0.00 (0.00,2.65) 0.00 (0.00,2.15) 0.00 (0.00,2.98) 0.00 (0.00,3.00) 0.00 (0.00,10.00) 23.284 < 0.001 Data are presented as mean ± SD or median (interquartile ranges); OC :osteocalcin; PTH :parathyroid hormone; β-CTX :β-CrossLaps; PINP :procollagen type I N-prepeptide; SMI :Skeletal muscle mass index; BMD :bone mineral density. a means compared with CO; b means compared with P-OS; c means compared with SP; d means compared with OP. 3.2 Comparison of diagnostic indicators of osteosarcopenia among different concentrations of osteocalcin We categorized subjects into three groups according to osteocalcin quartile levels: Q1 (≤ 11.09 ng/ml), Q2 (11.10–18.90 ng/ml), and Q3 (≥ 18.90 ng/ml). Overall, BMD, SMI, handgrip strength, and calf circumference decreased with the increasing osteocalcin concentrations (p < 0.05). The 6m walking speed and SARC-F have shown no significant differences among the three groups (Table 4 ). Table 4 Comparison of diagnostic indicators of osteosarcopenia among different concentrations of osteocalcin Q1 (n = 56) Q 2 (n = 110) Q3 (n = 58) F/H P -value Calf circumference(cm) 35.18 ± 2.36 34.15 ± 3.10 a 33.28 ± 3.09 a 6.005 0.003 Grip(kg) 26.91 ± 9.06 25.54 ± 10.02 a 22.95 ± 8.19 ab 296.145 < 0.001 6m walking speed(m/s) 1.04 ± 0.24 0.96 ± 0.22 a 0.95 ± 0.25 2.515 0.083 SMI(g/cm 2 ) 6.28 ± 0.74 6.04 ± 0.97 5.57 ± 0.70 ab 10.521 < 0.001 BMD(g/cm 2) Lumbar spine Total left hip Left femoral neck 0.98 ± 0.16 0.91 ± 0.19 a 0.87 ± 0.19 a 5.151 0.007 0.96 ± 0.13 0.86 ± 0.12 a 0.79 ± 0.16 ab 22.561 < 0.001 0.80 ± 0.15 0.71 ± 0.17 a 0.63 ± 0.15 ab 16.428 < 0.001 SARC-F ,median (Q1, Q3) 0.00(0.00,2.30) 1.00(0.00,3.00) 0.00(0.00,3.25) 0.899 0.638 variables are presented as mean ± SD or median (interquartile ranges); Q 1 : low concentration; Q 2 :moderate concentration; Q 3 : high concentration. SMI :Skeletal muscle mass index; BMD :bone mineral density. a means P < 0.05 compared with Q1; b means P < 0.05 compared with Q2. 3.3 Logistic regression analysis of osteocalcin and osteosarcopenia As shown in the Table 5 , a higher serum osteocalcin level was associated with a higher risk of OS (OR = 16.79, 95% CI (2.02-139.72)). After adjusted with several confounders, such as sex, age, BMI, UA, CRE, and hypertension in the serial models, and the results of association between serum osteocalcin and OS were still remained significance(OR = 10.84, 95% CI (1.24-95)). Meanwhile, we observed that the risk of OS increased as the serum osteocalcin level increased. Table 5 logistic regression analyses between osteocalcin and osteosarcopena in diferent models Q1 Q2 Q3 P Model 0 1.00 8.02(1.03–62.66)* 22.81(2.92-198.38)* 0.002 Model 1 1.00 6.58(0.80-54.17) 16.79(2.02-139.72)* 0.009 Model 2 1.00 5.10(0.59–44.54) 12.33(1.40-109.03)* 0.027 Model 3 1.00 4.97(0.58–42.58) 10.84(1.24-95.00)* 0.048 Results are OR(95% CI),*p < 0.05 Model 0:no adjusted Model 1: adjusted for age and sex Model 2: adjusted for model 1 plus BMI Model 3: adjusted for model 2 plus UA, CRE,hypertension 4. Discussion We mainly explored the relevance of osteocalcin to osteosarcopenia (osteoporosis + sarcopenia, OS) in elderly T2DM patients. we found that females and higher age are more susceptible to suffer OS, serum osteocalcin significantly increased in the OS patients. With the increase of serum osteocalcin, it was accompanied by a decrease of bone mineral density (BMD), skeletal muscle index (SMI), and handgrip strength, higher serum osteocalcin had a higher risk of OS. In the current study, 35 patients had osteosarcopenia (OS) among the 224 elder patients with type 2 diabetes, which accounted for 15.6%, slightly higher than the prevalence in those without diabetes [ 8 ]. We found that there were more female and older patients in the OS group, which is consistent with the community survey in China[ 9 ]. 47.3% of sarcopenic patients have the comorbidities of osteoporosis which suggested that sarcopenic patients are more likely to experience osteopenia [ 10 ]. Bone turnover biomarkers can be used to predict the rate of bone mass loss, which have not much reports in the OS studies. We found that serum β-CTX, OC, PINP, and ALP were increased in patients with OS, suggesting that bone turnover in patients with OS is accelerated. Our findings also showed that BMD, SMI, calf circumference, and grip strength showed a downward trend with the increase in OC concentration, which suggests that higher OC is a risk factor for impaired BMD, grip strength, and physical activity [ 11 , 12 ]. Moriwaki et al. (2019) utilized ultrasound BMD and bioelectrical impedance analysis for SMI in 254 Japan residents and reported the similar findings with the results in this study [ 13 ]. A 15-year longitudinal study covering 1261 elderly women further demonstrated that undercarboxylated osteocalcin (ucOC) and total osteocalcin (tOC) were negatively correlated with grip strength, that elderly women with a high ucOC / tOC ratio had the decreased physical functions and the increased risks of falls-related hospitalization [ 14 ]. Although animal studies suggest that osteocalcin appears to actively promote health and physical function, our results shown a different direction in the relationship between OC and muscle strength and physical activity in the elder patients. Therefore, it is speculated that the overexpression of OC is a compensatory mechanism for muscle strength impairment in the elderly, possibly through biochemical or biomechanical stimulation of osteoblasts due to the attenuation of muscle strength. Muraca et al. (2020) further reported that OC is involved in the regulation of OS through extracellular vehicles (EVs), with the changes in EVs and OC concentration affecting the incidence of OS [ 15 ] . Other factors influencing muscle and bone metabolism include kidney function, age, sex, and so on. It is well known that patients with high-age, female, chronic renal failure are prone to comorbid metabolic bone disease. Yang et al., (2016) found that OS is strongly associated with decreased renal function[ 16 ]. Our findings showed a significant increase in CRE in the OS group. We performed a multivariate logistic regression analysis, the resultssuggested that OC is a risk factor for OS after adjusted with several variables including creatinine, age, sex, etc.,. About fracture and osteosarcopenia in older people, a study from Iran suggested OC was a risk factor for OS (OR = 1.023) and was associated with an increased risk of OS [ 17 ]. For the association between OC and SMI and muscle strength, Xu et al. (2019) reported that serum OC level might affect SMI and was positively correlated with SMI in T2DM patients [ 18 ].Additionally, Levinger et al. (2014) found that the percentage of ucOC in women over 70 years was positively correlated with hip flexor strength, hip contraction strength, and quadriceps strength rather than tOC [ 19 ]. However, on study reported by Vitale et al. (2021), they found that serum tOC, but not ucOC, is positively correlated with SMI and muscle function in postmenopausal women [ 20 ]. Although OC can be classified according to the extent of γ-Gla carboxylation into cOC and ucOC, cOC is mainly located in bone and partially involved in bone mineralization, while ucOC plays a role in affecting muscle weight and strength. Those above studies suggest that ucOC/tOC may be more sensitive than single tOC value, and the relationship between ucOC/tOC ratio, OS parameters and outcome in falls, needs further investigation. There are several potential limitations in the present study. First, only tOC can be detected clinically at present, and we could not further distinguish ucOC and cOC. Osteocalcin has a biological rhythm and is susceptible to age, diet, exercise, gender, etc [ 21 – 23 ]. Second, because the present study is a cross-sectional study, the results cannot indicate a causal relationship between OC levels and OS. Last, because there are relatively few subjects, our results will still need to be validated in larger samples. 5. Conclusion In summary, we found a valuable association between a high level of OC and the incidence of osteosarcopenia, which OC can easily check in serum sampling and can have an important role in estimating the risk of osteosarcopenia incidence in elderly patients with T2DM. Further investigation on a larger scale is required to clarify the relationship between osteocalcin levels and OS. Abbreviations T2DM type 2 diabetes mellitus OP osteoporosis SO sarcopenia OS osteosarcopenia OC osteocalcin ucOC undercarboxylated osteocalcin cOC carboxylated osteocalcin tOC total osteocalcin β-CTX β-CrossLaps PINP Procollagen type I N-peptide PTH parathyroid hormone ALP alkaline phosphatase BMD bone mineral density ASMI appendicular skeletal muscle mass BMI body mass index CC calf circumference SARC-F Strength, Assistance in walking, Rise from a chair, Climb stairs, Falls questionnaire scoring scale Declarations Acknowledgements We are deeply grateful to all the study participants. Authors’contributions Junyan Li designed the project. Material preparation and data collection and analysis were performed by Niuniu Yuan, Na Li, Chuyue Yuan,and Qinqin Si, Huimin Shen measured bone metabolism markers. The first draft of the manuscript was written by Chuyue Yuan and Junyan Li. Junyan Li checked and edited the manuscripts. All authors read and approved the final version of the manuscript. Funding Funding was received from Shanxi Provincial Health Commission's "Four Batches" Science and Technology Medical Innovation Program (2021XM58) of Dr. Junyan Li. Availability of data and materials The datasets used and analysed during the current study are available from the corresponding author on reasonable request Ethics approval and consent to participate The study was approved by the ethics committee of Changzhi Medical College Affiliated Heji Hospital. All participants provided written informed consent before inclusion in the study, and all methods were conducted in accordance with pertinent guidelines and regulations. Consent for publication Not applicable. Competing interests The authors declare that they have no conflict of interest. References Zanker J, Duque G. Osteosarcopenia: the path beyond controversy . Curr Osteoporos Rep. 2020; 18 :81-84. Mesinovic J, Zengin A, De Courten B, Ebeling P, Scott D. 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Fahimfar N, Zahedi Tajrishi F, Gharibzadeh S, Shafiee G, Tanha K, Heshmat R, Nabipour I, Raeisi A, Jalili A, Larijani B. Prevalence of osteosarcopenia and its association with cardiovascular risk factors in Iranian older people: Bushehr Elderly Health (BEH) Program . Calcif Tissue Int. 2020; 106 :364-370. Wang YJ, Wang Y, Zhan JK, Tang ZY, He JY, Tan P, Deng HQ, Huang W, Liu YS. Sarco-osteoporosis: prevalence and association with frailty in Chinese community-dwelling older adults . Int J Endocrinol. 2015:482940. doi: 10.1155/2015/482940. Liu C, Liu N, Xia Y, Zhao Z, Xiao T, Li H. Osteoporosis and sarcopenia-related traits: A bi-directional Mendelian randomization study . Front Endocrinol (Lausanne). 2022; 13 :975647. Chen PY, Lee YH, Chiang CH, Chang HH, Lu CW, Huang KC. Sex Differences and Positive Dose–Response Relationships between Serum Osteocalcin Levels and Low Muscle Strength . Gerontology. 2023;69(9):1056-1064. Drey M, Sieber CC, Bertsch T, Bauer JM, Schmidmaier R. Osteosarcopenia is more than sarcopenia and osteopenia alone . Aging Clin Exp Res. 2016;28(5):895–899. Moriwaki K, Matsumoto H, Tanishima S, Tanimura C, Osaki M, Nagashima H, Hagino H. Association of serum bone-and muscle-derived factors with age, sex, body composition, and physical function in community-dwelling middle-aged and elderly adults: a cross-sectional study . BMC Musculoskelet Disord. 2019;20(1):276. Smith C, Lewis JR, Sim M, Lim WH, Lim EM, Blekkenhorst LC, Brennan‐Speranza TC, Adams L, Byrnes E, Duque G,et al. Higher Undercarboxylated to Total Osteocalcin Ratio Is Associated with Reduced Physical Function and Increased 15 ‐ Year Falls ‐ Related Hospitalizations: The Perth Longitudinal Study of Aging Women . J Bone Miner Res.2021;36(3):523-530. Muraca M, Cappariello A. The role of extracellular vesicles (EVs) in the epigenetic regulation of bone metabolism and osteoporosis . Int J Mol Sci. 2020;21(22):8682. Yang R, Zhang Y, Shen X, Yan S. Sarcopenia associated with renal function in the patients with type 2 diabetes . Diabetes Res Clin Pract.2016; 118 :121-129. Fathi M, Heshmat R, Ebrahimi M, Salimzadeh A, Ostovar A, Fathi A, Razi F, Nabipour I, Moghaddassi M, Shafiee G. Association between biomarkers of bone health and osteosarcopenia among Iranian older people: The Bushehr Elderly Health (BEH) program . BMC Geriatr. 2021;21(1):654. Xu Y, Ma X, Shen Y, Gu C, Tang J, Bao Y. Role of hyperglycaemia in the relationship between serum osteocalcin levels and relative skeletal muscle index . Clin Nutr. 2019; 38 (6):2704-2711. Levinger I, Scott D, Nicholson GC, Stuart AL, Duque G, McCorquodale T, Herrmann M, Ebeling PR, Sanders KM. Undercarboxylated osteocalcin, muscle strength and indices of bone health in older women . Bone. 2014; 64 :8-12. Vitale JA, Sansoni V, Faraldi M, Messina C, Verdelli C, Lombardi G, Corbetta S. Circulating carboxylated osteocalcin correlates with skeletal muscle mass and risk of fall in postmenopausal osteoporotic women . Front Endocrinol (Lausanne).2021; 12 :669704. Kim YS, Nam JS, Yeo DW, Kim KR, Suh SH, Ahn CW. The effects of aerobic exercise training on serum osteocalcin, adipocytokines and insulin resistance on obese young males . Clin Endocrinol(Oxf). 2015; 82 (5):686-694. Smith C, Lin X, Scott D, Brennan-Speranza TC, Al Saedi A, Moreno-Asso A, Woessner M, Hassan EB, Eynon N, Duque G: Uncovering the bone-muscle interaction and its implications for the health and function of older adults (the Wellderly Project): protocol for a randomized controlled crossover trial . JMIR Res Protoc. 2021; 10 (4):e18777. Smith C, Voisin S, Al Saedi A, Phu S, Brennan-Speranza T, Parker L, Eynon N, Hiam D, Yan X, Scott D. Osteocalcin and its forms across the lifespan in adult men . Bone. 2020; 130 :115085. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3940392","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":272642772,"identity":"902a1733-7da6-4e97-a7e3-91e4f6d7332f","order_by":0,"name":"Junyan Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYBACPmaGBAiLvbHh8I8KBh6CWtjgWngOH3zMcIYYLXCWRFqyMWMbEQ5jY2d4Jl3YZpfHwJBjJl04r07GnP0A44ePOXgdliY9sy25mIHhjJn0zG2HeSx7EpglZ24joIW3jTmxgbHHTIJ32wEegwMJbMy8hLXUJzYw8wC1zKnjMTj/gCgthxMb2NiSjXmBGg1uELYl2Zrn3PHEBh7mgw9nHDsM1PKwGa9f+PnPJN7mKatObJB/2HDgQ02dvcH55IMfPuLRAozCBAZGYOzYH4CLMDbgUw8E7EC1fwioGQWjYBSMgpENAD/bSOUYgi/XAAAAAElFTkSuQmCC","orcid":"","institution":"Heji Hospital affiliated to Changzhi Medical College","correspondingAuthor":true,"prefix":"","firstName":"Junyan","middleName":"","lastName":"Li","suffix":""},{"id":272642773,"identity":"882aaa73-96b0-4419-977f-a953ea21b83b","order_by":1,"name":"Qinqin Si","email":"","orcid":"","institution":"Heji Hospital affiliated to Changzhi Medical College","correspondingAuthor":false,"prefix":"","firstName":"Qinqin","middleName":"","lastName":"Si","suffix":""},{"id":272642774,"identity":"026b34c9-4662-480b-9b8d-7f684e617543","order_by":2,"name":"chuyue yuan","email":"","orcid":"","institution":"Heji Hospital affiliated to Changzhi Medical College","correspondingAuthor":false,"prefix":"","firstName":"chuyue","middleName":"","lastName":"yuan","suffix":""},{"id":272642775,"identity":"06fe7a99-3f5f-43d0-b9d7-935e0d02187a","order_by":3,"name":"Na Li","email":"","orcid":"","institution":"Heji Hospital affiliated to Changzhi Medical College","correspondingAuthor":false,"prefix":"","firstName":"Na","middleName":"","lastName":"Li","suffix":""},{"id":272642776,"identity":"b39aeec4-50a6-451e-9d10-8c7f5a0e7372","order_by":4,"name":"Niuniu Yuan","email":"","orcid":"","institution":"The Second People’s Hospital of Pingdingshan","correspondingAuthor":false,"prefix":"","firstName":"Niuniu","middleName":"","lastName":"Yuan","suffix":""},{"id":272642777,"identity":"c2e54584-f105-4f01-97a2-2c878d5c88fe","order_by":5,"name":"Huimin Shen","email":"","orcid":"","institution":"Heji Hospital affiliated to Changzhi Medical College","correspondingAuthor":false,"prefix":"","firstName":"Huimin","middleName":"","lastName":"Shen","suffix":""}],"badges":[],"createdAt":"2024-02-08 15:30:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3940392/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3940392/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52875760,"identity":"c6c78838-0734-4968-af85-be9325ee15fc","added_by":"auto","created_at":"2024-03-18 08:14:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":951115,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3940392/v1/b6042030-e0d5-40fd-8e93-0ec5c79bd638.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Serum Osteocalcin as a Risk Factor for osteosarcopenia in elderly patients with T2DM","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSarcopenia and osteoporosis seriously threaten the health of elderly patients with type 2 diabetes (T2DM). Those two diseases have overlapping in genetic background, physiology, and pathology and frequently present in the form of comorbidities. In 2019, the concept of osteosarcopenia (OS) was proposed for this comorbidities disease [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Subsequently, it was found that the occurrence of osteosarcopenia was significantly increased in elderly patients with T2DM [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. So early diagnostic of osteosarcopenia is necessary elderly patients with T2DM to improve the prognosis, treatment, and life quality of patients.\u003c/p\u003e \u003cp\u003eCurrently, the diagnostic procedure for osteosarcopenia is relatively complex and lacks sensitive biomarkers. Muscle-skeleton crosstalk provides novel insights into the pathogenesis of the comorbidity. We focused on musculoskeletal crosstalk and investigated the relationship between bone metabolism markers and muscle tissue metabolism, in order to screen out the effective biomarkers and therapeutic targets of osteosarcopenia.\u003c/p\u003e \u003cp\u003eOsteocalcin (OC) as a cytokine released by osteoblasts mediated into in the important processes including bone metabolism, glycolipid metabolism, and cognition and emotion improvement, exercise modulation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]). In recent animal studies, it was found that OC induced myoblast proliferation and differentiation, promoted muscle protein synthesis, increased muscle content and muscle fiber strength [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and improved muscle endurance, muscle metabolism and function [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].At present, the relationship between OC and osteosarcopenia remains unknown. Therefore, the purpose of this study is to explore the correlation between osteocalcin and osteosarcopenia in elderly patients with T2DM, to find an effective biomarker for osteosarcopenia in the elderly patients with T2DM which provided a theoretical basis for early clinical intervention.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Participants\u003c/h2\u003e \u003cp\u003eT2DM patients with an age greater than 60 years were consecutively recruited from the inpatient population of the Department of Endocrinology at Heji Hospital, affiliated with Changzhi Medical College, between September 2021 and September 2023. All participants provided written informed consent before inclusion in the study. And the study was approved by the ethics committee of Changzhi Medical College Affiliated Heji Hospital. The exclusion criteria were as follows: 1) patients with type 1 diabetes mellitus or other specific types of diabetes; 2) patients with long-term nutritional deficiency, low calcium, a history of heavy smoking, long-term bed rest, a tumor, a mental illness, cognitive communication impairment, or mobility difficulties who cannot cooperate with the examination; 3) patients who have devices in the body such as pacemakers or metal stents that affect the analysis of body composition; 4) patients who have used drugs that can affect bone metabolism (such as glucocorticoids, antiepileptic drugs, bisphosphonates, etc.; 5) patients with hyperthyroidism, hyperparathyroidism, Cushing\u0026rsquo;s syndrome, rheumatoid arthritis, and abnormal liver and kidney function\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Groups of osteosarcopenia\u003c/h2\u003e \u003cp\u003eThe diagnostic criteria for sacopenia refer to the consensus that was published by the Asian Sarcopenia Working Group (AWGS) in 2019, which defined sarcopenia as low muscle mass, decreased muscle strength, and/or decreased physical function. Low muscle mass was defined using the SMI; the cutoff value was 7.0 kg/m2 in men and 5.4 kg/m2 in women. Decreased muscle strength was defined as grip strength below 18kg for females and below 28kg for males. Decreased physical function was defined as walking speed\u0026thinsp;\u0026le;\u0026thinsp;1.0 m/s. In order to diagnose sarcopenia, either ①+② or ①+③ must be fulfilled, and severe sarcopenia was defined as ①+②+③. The diagnosis of osteoporosis was based on the World Health Organization\u0026rsquo;s (WHO) classification system: T-scores \u0026le; -2.5 SD indicate osteoporosis; those between \u0026minus;\u0026thinsp;2.5 SD and \u0026minus;\u0026thinsp;1.0 SD indicate osteopenia; and T-scores \u0026ge; -1.0 SD indicate normal bone density. According to the above diagnostic criteria, all enrolled elderly T2DM patients were divided into the following five groups: (1) Group Controls (CO): normal BMD and SMI; (2) Group Pre-osteosarcopenia: osteopenia with or without low muscle mass; (3) Group Sarcopenia (SP): sarcopenia without osteoporosis; (4) Group Osteoporosis (OP): osteoporosis without sarcopenia; (5) Group Osteosarcopenia (OS): osteoporosis\u0026thinsp;+\u0026thinsp;sarcopenia.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Clinical features collection\u003c/h2\u003e \u003cp\u003eWe collected demographic information, including age, duration of diabetes, age of menopause, marriage and childbearing history, smoking and drinking history, SARC-F questionnaire scoring scale, medications, complications, and concomitant diseases, etc. Meanwhile we measured height, weight, and body mass index (BMI) of each subject.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Biochemical Measurements\u003c/h2\u003e \u003cp\u003eBlood samples were extracted from each patient in the morning for biochemical tests. General biochemical indicators such as liver and kidney function, glycated Haemoglobin (HbA1c), blood lipids, and so on were performed with standard methods. We also tested some bone metabolism markers, including osteocalcin (OC), procollagen type I N-prepeptide (PINP), β-Cross Laps (β-CTX), and parathyroid hormone (PTH), with an electrochemical luminescence immunoassay kit (Roche, Germany)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Handgrip strength and calf circumference\u003c/h2\u003e \u003cp\u003eWe measured the maximal handgrip strength of the dominant hand with a hand-held dynamometer (Jamar, USA). At the process of measurement, the participants should seat, keep shoulder adduction, make elbow flex at 90\u0026deg;, and forearm in a neutral position. The participants should squeeze the device as forcefully as possible, and the highest scores among three tests were recorded. We also measured the calf circumference (CC) of both legs when the patient seated with knee flexion of 90\u0026deg;, and relaxed with foot and ankle joints..\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 The walking speed of 6 meters\u003c/h2\u003e \u003cp\u003eIn order to record the walking speed of the subject (6 m), we record the time of 6-meterswalking at the normal walking speed. We tested three times, and recorded the fastest speed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.7 DXA measurement\u003c/h2\u003e \u003cp\u003eWe evaluated the lumbar spine (L1\u0026ndash;L4) and left hip BMD (g/cm\u003csup\u003e2\u003c/sup\u003e) with a dual-energy X-ray absorptiometry (DXA) scanner (QDR Discovery, MA, USA). And the left hip evaluation included the femoral neck, trochanter, and shaft, as well as the total femur. The least significant changes (LSCs) of the lumbar spine and femoral neck were 0.021 g/cm2 and 0.030 g/cm2, respectively. We also assess the whole-body composition including skeletal muscle mass and fat mass. Skeletal muscle index (SMI) was calculated as the sum of the lean mass of both arms and legs and was divided by squared body height (kg/m\u003csup\u003e2\u003c/sup\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.8 Statistical Analysis\u003c/h2\u003e \u003cp\u003eAll data were statistically analyzed using SPSS 26.0 (SPSS Inc., Chicago, IL, United States). For continuous variables, normality tests were performed using the Kolmogorov-Smirnov test. The measurement data conforming to a normal distribution were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s), and ANVOA analysis was used to compare groups. Those data that did not conform to the normal distribution were expressed by the quartile [M (P25, P75)], and the comparison between groups was tested by the Kruskal-Wallis H test. The enumeration data were expressed in percentages, and a chi-square test was used for comparison between groups. Logistic regression analysis was used to analyze the relationship between osteoscarsopenia and osteocalcin. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to be statistically significant for all tests.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Comparison of general characteristics and musculoskeletal indicates of elderly patients with T2DM\u003c/h2\u003e \u003cp\u003eA total of 224 patients over 60 years old were included in this study (age: 60\u0026ndash;85 years, BMI: 14.12\u0026ndash;34.10 kg/m\u003csup\u003e2\u003c/sup\u003e, and disease duration range: 0.1\u0026ndash;30 years), who were then divided into five groups, including 119 females and 105 males, of whom 15.6% were OS. Compared with the Group CO, the patients in Group OS were relatively elder and had a lower BMI index (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); there was no significant difference in complications of diabetes and hypertension among all groups (Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003e \u003cb\u003eTabel 1\u003c/b\u003e Comparison of general clinical characteristics among five groups\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCO\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-OS\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSP\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOP\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eF/χ\u003csup\u003e2\u003c/sup\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale,n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20(54.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (34.8)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19(48.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37(75.5)\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24(68.6)\u003csup\u003ebc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e24.498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e11.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of diabetes(years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.947\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI(kg/cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003csup\u003eabcd\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6.522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension,n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19(51.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(61.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25(51.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22(62.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4.183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.382\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetic nephropathy,n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11(31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7.762\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetic retinopathy,n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6(16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(30.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5.602\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetic peripheral vasculopathy,n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61(88.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28(82.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44(89.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28(80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetic peripheral neuropathy,n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17(45.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48(69.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(61.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29(59.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24(68.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6.534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or number (%); \u003cem\u003eOS\u003c/em\u003e:osteoporosis with sarcopenia; \u003cem\u003eP-OS\u003c/em\u003e:osteopenia with/ without low SMI;\u003cem\u003eSP\u003c/em\u003e: sarcopenia without osteoporosis;\u003cem\u003eOP\u003c/em\u003e: osteoporosis without sarcopenia; \u003cem\u003eCO\u003c/em\u003e: normal BMD and SMI.\u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003e indicates significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) to CO; \u003csup\u003eb\u003c/sup\u003e indicates significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) to P-OS; \u003csup\u003ec\u003c/sup\u003e indicates significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) to SP;\u003csup\u003ed\u003c/sup\u003e indicates significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) to OP.\u003c/p\u003e \u003cp\u003eThere were no significant differences in the levels of HbA1c, ALB, ALT, AST, TG, TC, LDL-C, and HDL-C among all groups, except for ALP, CRE, and UA (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of routine biochemical indexes among five groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 14.4263%;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003eCO\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003eP-OS\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 13.3675%;\"\u003e\n \u003cp\u003eSP\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 14.0293%;\"\u003e\n \u003cp\u003eOP\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 14.294%;\"\u003e\n \u003cp\u003eOS\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 7.4117%;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 7.2793%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.3528%;\"\u003e\n \u003cp\u003eHbA1c(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e8.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e8.74\u0026thinsp;\u0026plusmn;\u0026thinsp;2.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.3675%;\"\u003e\n \u003cp\u003e8.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.0293%;\"\u003e\n \u003cp\u003e8.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.294%;\"\u003e\n \u003cp\u003e9.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.4117%;\"\u003e\n \u003cp\u003e0.729\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2793%;\"\u003e\n \u003cp\u003e0.573\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.3528%;\"\u003e\n \u003cp\u003eTP(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e71.00\u0026thinsp;\u0026plusmn;\u0026thinsp;6.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e70.28\u0026thinsp;\u0026plusmn;\u0026thinsp;6.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.3675%;\"\u003e\n \u003cp\u003e71.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.0293%;\"\u003e\n \u003cp\u003e71.63\u0026thinsp;\u0026plusmn;\u0026thinsp;4.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.294%;\"\u003e\n \u003cp\u003e72.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.4117%;\"\u003e\n \u003cp\u003e1.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2793%;\"\u003e\n \u003cp\u003e0.199\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.3528%;\"\u003e\n \u003cp\u003eALB(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e41.38\u0026thinsp;\u0026plusmn;\u0026thinsp;5.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e42.17\u0026thinsp;\u0026plusmn;\u0026thinsp;3.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.3675%;\"\u003e\n \u003cp\u003e42.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.0293%;\"\u003e\n \u003cp\u003e42.37\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.294%;\"\u003e\n \u003cp\u003e41.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.4117%;\"\u003e\n \u003cp\u003e0.380\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2793%;\"\u003e\n \u003cp\u003e0.823\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.3528%;\"\u003e\n \u003cp\u003eALT(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e22.78\u0026thinsp;\u0026plusmn;\u0026thinsp;16.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e21.65\u0026thinsp;\u0026plusmn;\u0026thinsp;12.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.3675%;\"\u003e\n \u003cp\u003e21.53\u0026thinsp;\u0026plusmn;\u0026thinsp;13.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.0293%;\"\u003e\n \u003cp\u003e28.84\u0026thinsp;\u0026plusmn;\u0026thinsp;28.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.294%;\"\u003e\n \u003cp\u003e19.09\u0026thinsp;\u0026plusmn;\u0026thinsp;17.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.4117%;\"\u003e\n \u003cp\u003e1.730\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2793%;\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.3528%;\"\u003e\n \u003cp\u003eAST(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e22.25\u0026thinsp;\u0026plusmn;\u0026thinsp;9.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e21.30\u0026thinsp;\u0026plusmn;\u0026thinsp;7.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.3675%;\"\u003e\n \u003cp\u003e20.97\u0026thinsp;\u0026plusmn;\u0026thinsp;7.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.0293%;\"\u003e\n \u003cp\u003e26.47\u0026thinsp;\u0026plusmn;\u0026thinsp;14.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.294%;\"\u003e\n \u003cp\u003e21.69\u0026thinsp;\u0026plusmn;\u0026thinsp;11.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.4117%;\"\u003e\n \u003cp\u003e2.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2793%;\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.3528%;\"\u003e\n \u003cp\u003eALP(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e84.61\u0026thinsp;\u0026plusmn;\u0026thinsp;24.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e77.58\u0026thinsp;\u0026plusmn;\u0026thinsp;21.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.3675%;\"\u003e\n \u003cp\u003e73.59\u0026thinsp;\u0026plusmn;\u0026thinsp;15.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.0293%;\"\u003e\n \u003cp\u003e94.82\u0026thinsp;\u0026plusmn;\u0026thinsp;34.52\u003csup\u003ebc\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.294%;\"\u003e\n \u003cp\u003e93.20\u0026thinsp;\u0026plusmn;\u0026thinsp;24.93\u003csup\u003ebc\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.4117%;\"\u003e\n \u003cp\u003e5.895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2793%;\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.3528%;\"\u003e\n \u003cp\u003eTCH(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e4.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e4.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.3675%;\"\u003e\n \u003cp\u003e3.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.0293%;\"\u003e\n \u003cp\u003e4.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.294%;\"\u003e\n \u003cp\u003e4.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.4117%;\"\u003e\n \u003cp\u003e1.791\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2793%;\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.3528%;\"\u003e\n \u003cp\u003eTG(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e1.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e1.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.3675%;\"\u003e\n \u003cp\u003e1.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.0293%;\"\u003e\n \u003cp\u003e1.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.294%;\"\u003e\n \u003cp\u003e1.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.4117%;\"\u003e\n \u003cp\u003e0.530\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2793%;\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.3528%;\"\u003e\n \u003cp\u003eHDL-C(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e1.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e1.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.3675%;\"\u003e\n \u003cp\u003e1.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.0293%;\"\u003e\n \u003cp\u003e1.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.294%;\"\u003e\n \u003cp\u003e1.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.4117%;\"\u003e\n \u003cp\u003e1.212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2793%;\"\u003e\n \u003cp\u003e0.306\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.3528%;\"\u003e\n \u003cp\u003eLDL-C(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e2.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e2.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.3675%;\"\u003e\n \u003cp\u003e2.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.0293%;\"\u003e\n \u003cp\u003e2.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.294%;\"\u003e\n \u003cp\u003e2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.4117%;\"\u003e\n \u003cp\u003e1.712\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2793%;\"\u003e\n \u003cp\u003e0.148\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.3528%;\"\u003e\n \u003cp\u003eBUN(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e6.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e5.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.3675%;\"\u003e\n \u003cp\u003e5.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.0293%;\"\u003e\n \u003cp\u003e5.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.294%;\"\u003e\n \u003cp\u003e5.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.4117%;\"\u003e\n \u003cp\u003e1.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2793%;\"\u003e\n \u003cp\u003e0.318\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.3528%;\"\u003e\n \u003cp\u003eCRE(\u0026micro;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e60.00\u0026thinsp;\u0026plusmn;\u0026thinsp;19.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e70.71\u0026thinsp;\u0026plusmn;\u0026thinsp;18.73\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.3675%;\"\u003e\n \u003cp\u003e68.29\u0026thinsp;\u0026plusmn;\u0026thinsp;15.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.0293%;\"\u003e\n \u003cp\u003e61.37\u0026thinsp;\u0026plusmn;\u0026thinsp;13.01\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.294%;\"\u003e\n \u003cp\u003e70.09\u0026thinsp;\u0026plusmn;\u0026thinsp;23.77\u003csup\u003ead\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.4117%;\"\u003e\n \u003cp\u003e3.323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2793%;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.3528%;\"\u003e\n \u003cp\u003eUA(\u0026micro;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e278.75\u0026thinsp;\u0026plusmn;\u0026thinsp;104.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e318.54\u0026thinsp;\u0026plusmn;\u0026thinsp;93.64\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.3675%;\"\u003e\n \u003cp\u003e286.29\u0026thinsp;\u0026plusmn;\u0026thinsp;67.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.0293%;\"\u003e\n \u003cp\u003e288.80\u0026thinsp;\u0026plusmn;\u0026thinsp;93.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.294%;\"\u003e\n \u003cp\u003e265.51\u0026thinsp;\u0026plusmn;\u0026thinsp;64.73\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.4117%;\"\u003e\n \u003cp\u003e2.617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2793%;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.3528%;\"\u003e\n \u003cp\u003eCa(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e2.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e2.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.3675%;\"\u003e\n \u003cp\u003e2.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.0293%;\"\u003e\n \u003cp\u003e2.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.294%;\"\u003e\n \u003cp\u003e2.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.4117%;\"\u003e\n \u003cp\u003e0.752\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2793%;\"\u003e\n \u003cp\u003e0.558\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.3528%;\"\u003e\n \u003cp\u003eP(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.1616%;\"\u003e\n \u003cp\u003e1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.3675%;\"\u003e\n \u003cp\u003e1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.0293%;\"\u003e\n \u003cp\u003e1.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.294%;\"\u003e\n \u003cp\u003e1.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.4117%;\"\u003e\n \u003cp\u003e0.888\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2793%;\"\u003e\n \u003cp\u003e0.472\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp\u003eData are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.HbA1c: glycosylated hemoglobin;TP:total protein;ALB:albumin;ALT:alanine aminotransferase;AST:aspartate aminotransferase;ALP:alkaline phosphatase; TCH : total cholesterol; TG:triglyceride;HDL-C:high density lipoprotein cholesterin;LDL-C:low density lipoprotein cholesterin;BUN:blood urea nitrogen;CRE:creatinine;UA:Uric Acid; \u003csup\u003ea\u003c/sup\u003e means compared with CO; \u003csup\u003eb\u003c/sup\u003e means compared with P-OS; \u003csup\u003ec\u003c/sup\u003e means compared with SP;\u003csup\u003ed\u003c/sup\u003e means compared with OP.\u003c/p\u003e \u003cp\u003eThe levels of OC, β-CTX, and PINP in the OS group significantly increased (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the waist-hip ratio, SARC-F scale score, calf circumference, SMI, BMD, and grip strength significantly decreased compared to the other groups ( Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of musculoskeletal indicates among five groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCO\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-OS\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSP\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOP\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eF/H\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalf circumference(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.61\u0026thinsp;\u0026plusmn;\u0026thinsp;3.38\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.24\u003csup\u003eabcd\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.668\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHandgrip strength (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.42\u0026thinsp;\u0026plusmn;\u0026thinsp;9.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.79\u0026thinsp;\u0026plusmn;\u0026thinsp;9.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.90\u0026thinsp;\u0026plusmn;\u0026thinsp;8.84\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.41\u0026thinsp;\u0026plusmn;\u0026thinsp;7.82\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.71\u0026thinsp;\u0026plusmn;\u0026thinsp;9.38\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6m walking speed(m/s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003csup\u003eabd\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.975\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal body fat percentage(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.63\u0026thinsp;\u0026plusmn;\u0026thinsp;6.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.05\u0026thinsp;\u0026plusmn;\u0026thinsp;5.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.22\u0026thinsp;\u0026plusmn;\u0026thinsp;7.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.49\u0026thinsp;\u0026plusmn;\u0026thinsp;6.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.31\u0026thinsp;\u0026plusmn;\u0026thinsp;8.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.401\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWaist-Hip ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003csup\u003ebcd\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSMI(g/cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003csup\u003eabcd\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBMD(g/cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003cp\u003eLumbar spine \u003c/p\u003e \u003cp\u003eTotal left hip\u003c/p\u003e \u003cp\u003eLeft femoral neck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e91.944\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e44.536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOC(ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.01\u0026thinsp;\u0026plusmn;\u0026thinsp;3.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.27\u0026thinsp;\u0026plusmn;\u0026thinsp;6.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.49\u0026thinsp;\u0026plusmn;\u0026thinsp;5.63\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.13\u0026thinsp;\u0026plusmn;\u0026thinsp;7.66\u003csup\u003eabcd\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.748\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePINP(ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.11\u0026thinsp;\u0026plusmn;\u0026thinsp;11.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.33\u0026thinsp;\u0026plusmn;\u0026thinsp;12.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.50\u0026thinsp;\u0026plusmn;\u0026thinsp;10.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46.10\u0026thinsp;\u0026plusmn;\u0026thinsp;16.68\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45.77\u0026thinsp;\u0026plusmn;\u0026thinsp;14.55\u003csup\u003ebc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eβ-CTX(ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.876\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTH(pg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.30\u0026thinsp;\u0026plusmn;\u0026thinsp;12.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.02\u0026thinsp;\u0026plusmn;\u0026thinsp;21.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.69\u0026thinsp;\u0026plusmn;\u0026thinsp;14.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50.12\u0026thinsp;\u0026plusmn;\u0026thinsp;26.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e49.58\u0026thinsp;\u0026plusmn;\u0026thinsp;23.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25.558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSARC-F, median (Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003cp\u003e(0.00,2.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003cp\u003e(0.00,2.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003cp\u003e(0.00,2.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003cp\u003e(0.00,3.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003cp\u003e(0.00,10.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eData are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or median (interquartile ranges); \u003cem\u003eOC\u003c/em\u003e:osteocalcin;\u003cem\u003ePTH\u003c/em\u003e:parathyroid hormone;\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eβ-CTX\u003c/em\u003e:β-CrossLaps;\u003cem\u003ePINP\u003c/em\u003e:procollagen type I N-prepeptide; \u003cem\u003eSMI\u003c/em\u003e:Skeletal muscle mass index;\u003cem\u003eBMD\u003c/em\u003e:bone mineral density.\u003csup\u003ea\u003c/sup\u003emeans compared with CO; \u003csup\u003eb\u003c/sup\u003emeans compared with P-OS; \u003csup\u003ec\u003c/sup\u003e means compared with SP;\u003csup\u003ed\u003c/sup\u003e means compared with OP.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Comparison of diagnostic indicators of osteosarcopenia among different concentrations of osteocalcin\u003c/h2\u003e \u003cp\u003eWe categorized subjects into three groups according to osteocalcin quartile levels: Q1 (\u0026le;\u0026thinsp;11.09 ng/ml), Q2 (11.10\u0026ndash;18.90 ng/ml), and Q3 (\u0026ge;\u0026thinsp;18.90 ng/ml). Overall, BMD, SMI, handgrip strength, and calf circumference decreased with the increasing osteocalcin concentrations (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The 6m walking speed and SARC-F have shown no significant differences among the three groups (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of diagnostic indicators of osteosarcopenia among different concentrations of osteocalcin\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQ1 (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQ\u003csub\u003e2\u003c/sub\u003e (n\u0026thinsp;=\u0026thinsp;110)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQ3 (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eF/H\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalf circumference(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.18\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.10\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.28\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrip(kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.91\u0026thinsp;\u0026plusmn;\u0026thinsp;9.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.54\u0026thinsp;\u0026plusmn;\u0026thinsp;10.02\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.95\u0026thinsp;\u0026plusmn;\u0026thinsp;8.19\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e296.145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6m walking speed(m/s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.515\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSMI(g/cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.521\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBMD(g/cm\u003csup\u003e2)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eLumbar spine \u003c/p\u003e \u003cp\u003eTotal left hip\u003c/p\u003e \u003cp\u003eLeft femoral neck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSARC-F ,median (Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.00(0.00,2.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00(0.00,3.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00(0.00,3.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.638\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003evariables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or median (interquartile ranges);\u003cem\u003eQ\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e: low concentration;\u003cem\u003eQ\u003c/em\u003e\u003csub\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sub\u003e:moderate concentration;\u003cem\u003eQ\u003c/em\u003e\u003csub\u003e\u003cem\u003e3\u003c/em\u003e\u003c/sub\u003e: high concentration. \u003cem\u003eSMI\u003c/em\u003e :Skeletal muscle mass index; \u003cem\u003eBMD\u003c/em\u003e:bone mineral density. \u003csup\u003ea\u003c/sup\u003e means P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared with Q1; \u003csup\u003eb\u003c/sup\u003e means P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared with Q2.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Logistic regression analysis of osteocalcin and osteosarcopenia\u003c/h2\u003e \u003cp\u003eAs shown in the Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e5\u003c/span\u003e, a higher serum osteocalcin level was associated with a higher risk of OS (OR\u0026thinsp;=\u0026thinsp;16.79, 95% CI (2.02-139.72)). After adjusted with several confounders, such as sex, age, BMI, UA, CRE, and hypertension in the serial models, and the results of association between serum osteocalcin and OS were still remained significance(OR\u0026thinsp;=\u0026thinsp;10.84, 95% CI (1.24-95)). Meanwhile, we observed that the risk of OS increased as the serum osteocalcin level increased.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003elogistic regression analyses between osteocalcin and osteosarcopena in diferent models\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQ2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQ3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.02(1.03\u0026ndash;62.66)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.81(2.92-198.38)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.58(0.80-54.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.79(2.02-139.72)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.10(0.59\u0026ndash;44.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.33(1.40-109.03)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.97(0.58\u0026ndash;42.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.84(1.24-95.00)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eResults are OR(95% CI),*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eModel 0:no adjusted\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eModel 1: adjusted for age and sex\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eModel 2: adjusted for model 1 plus BMI\u003c/p\u003e \u003cp\u003eModel 3: adjusted for model 2 plus UA, CRE,hypertension\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eWe mainly explored the relevance of osteocalcin to osteosarcopenia (osteoporosis\u0026thinsp;+\u0026thinsp;sarcopenia, OS) in elderly T2DM patients. we found that females and higher age are more susceptible to suffer OS, serum osteocalcin significantly increased in the OS patients. With the increase of serum osteocalcin, it was accompanied by a decrease of bone mineral density (BMD), skeletal muscle index (SMI), and handgrip strength, higher serum osteocalcin had a higher risk of OS.\u003c/p\u003e \u003cp\u003eIn the current study, 35 patients had osteosarcopenia (OS) among the 224 elder patients with type 2 diabetes, which accounted for 15.6%, slightly higher than the prevalence in those without diabetes [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. We found that there were more female and older patients in the OS group, which is consistent with the community survey in China[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. 47.3% of sarcopenic patients have the comorbidities of osteoporosis which suggested that sarcopenic patients are more likely to experience osteopenia [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBone turnover biomarkers can be used to predict the rate of bone mass loss, which have not much reports in the OS studies. We found that serum β-CTX, OC, PINP, and ALP were increased in patients with OS, suggesting that bone turnover in patients with OS is accelerated. Our findings also showed that BMD, SMI, calf circumference, and grip strength showed a downward trend with the increase in OC concentration, which suggests that higher OC is a risk factor for impaired BMD, grip strength, and physical activity [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Moriwaki et al. (2019) utilized ultrasound BMD and bioelectrical impedance analysis for SMI in 254 Japan residents and reported the similar findings with the results in this study [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A 15-year longitudinal study covering 1261 elderly women further demonstrated that undercarboxylated osteocalcin (ucOC) and total osteocalcin (tOC) were negatively correlated with grip strength, that elderly women with a high ucOC / tOC ratio had the decreased physical functions and the increased risks of falls-related hospitalization [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Although animal studies suggest that osteocalcin appears to actively promote health and physical function, our results shown a different direction in the relationship between OC and muscle strength and physical activity in the elder patients. Therefore, it is speculated that the overexpression of OC is a compensatory mechanism for muscle strength impairment in the elderly, possibly through biochemical or biomechanical stimulation of osteoblasts due to the attenuation of muscle strength. Muraca et al. (2020) further reported that OC is involved in the regulation of OS through extracellular vehicles (EVs), with the changes in EVs and OC concentration affecting the incidence of OS [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eOther factors influencing muscle and bone metabolism include kidney function, age, sex, and so on. It is well known that patients with high-age, female, chronic renal failure are prone to comorbid metabolic bone disease. Yang et al., (2016) found that OS is strongly associated with decreased renal function[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Our findings showed a significant increase in CRE in the OS group. We performed a multivariate logistic regression analysis, the resultssuggested that OC is a risk factor for OS after adjusted with several variables including creatinine, age, sex, etc.,. About fracture and osteosarcopenia in older people, a study from Iran suggested OC was a risk factor for OS (OR\u0026thinsp;=\u0026thinsp;1.023) and was associated with an increased risk of OS [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. For the association between OC and SMI and muscle strength, Xu et al. (2019) reported that serum OC level might affect SMI and was positively correlated with SMI in T2DM patients [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].Additionally, Levinger et al. (2014) found that the percentage of ucOC in women over 70 years was positively correlated with hip flexor strength, hip contraction strength, and quadriceps strength rather than tOC [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, on study reported by Vitale et al. (2021), they found that serum tOC, but not ucOC, is positively correlated with SMI and muscle function in postmenopausal women [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Although OC can be classified according to the extent of γ-Gla carboxylation into cOC and ucOC, cOC is mainly located in bone and partially involved in bone mineralization, while ucOC plays a role in affecting muscle weight and strength. Those above studies suggest that ucOC/tOC may be more sensitive than single tOC value, and the relationship between ucOC/tOC ratio, OS parameters and outcome in falls, needs further investigation.\u003c/p\u003e \u003cp\u003eThere are several potential limitations in the present study. First, only tOC can be detected clinically at present, and we could not further distinguish ucOC and cOC. Osteocalcin has a biological rhythm and is susceptible to age, diet, exercise, gender, etc [\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Second, because the present study is a cross-sectional study, the results cannot indicate a causal relationship between OC levels and OS. Last, because there are relatively few subjects, our results will still need to be validated in larger samples.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn summary, we found a valuable association between a high level of OC and the incidence of osteosarcopenia, which OC can easily check in serum sampling and can have an important role in estimating the risk of osteosarcopenia incidence in elderly patients with T2DM. Further investigation on a larger scale is required to clarify the relationship between osteocalcin levels and OS.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eT2DM\u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;type 2 diabetes mellitus\u003c/p\u003e\n\u003cp\u003eOP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;osteoporosis\u003c/p\u003e\n\u003cp\u003eSO\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;sarcopenia\u003c/p\u003e\n\u003cp\u003eOS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;osteosarcopenia\u003c/p\u003e\n\u003cp\u003eOC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; osteocalcin\u003c/p\u003e\n\u003cp\u003eucOC\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; undercarboxylated osteocalcin\u003c/p\u003e\n\u003cp\u003ecOC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; carboxylated osteocalcin\u0026nbsp;\u003c/p\u003e\n\u003cp\u003etOC\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; total osteocalcin\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026beta;-CTX\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026beta;-CrossLaps\u003c/p\u003e\n\u003cp\u003ePINP\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Procollagen type I N-peptide\u003c/p\u003e\n\u003cp\u003ePTH\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; parathyroid hormone\u003c/p\u003e\n\u003cp\u003eALP\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; alkaline phosphatase\u003c/p\u003e\n\u003cp\u003eBMD\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; bone mineral density\u003c/p\u003e\n\u003cp\u003eASMI\u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;appendicular skeletal muscle mass\u003c/p\u003e\n\u003cp\u003eBMI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; body mass index\u003c/p\u003e\n\u003cp\u003eCC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;calf circumference\u003c/p\u003e\n\u003cp\u003eSARC-F \u0026nbsp; \u0026nbsp; \u0026nbsp;Strength, Assistance in walking, Rise from a chair, Climb stairs, Falls questionnaire scoring scale\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are deeply grateful to all the study participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo;contributions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJunyan Li designed the project. Material preparation and data collection and analysis were performed by Niuniu Yuan, Na Li, Chuyue Yuan,and Qinqin Si, Huimin Shen measured bone metabolism markers. The first draft of the manuscript was written by Chuyue Yuan and Junyan Li. Junyan Li checked and edited the manuscripts. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding was received from Shanxi Provincial Health Commission\u0026apos;s \u0026quot;Four Batches\u0026quot; Science and Technology Medical Innovation Program (2021XM58) of Dr. Junyan Li.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the ethics committee of Changzhi Medical College Affiliated Heji Hospital. All participants provided written informed consent before inclusion in the study, and all methods were conducted in accordance with pertinent guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZanker J, Duque G. \u003cstrong\u003eOsteosarcopenia: the path beyond controversy\u003c/strong\u003e. Curr Osteoporos Rep. 2020; \u003cstrong\u003e18\u003c/strong\u003e:81-84.\u003c/li\u003e\n\u003cli\u003eMesinovic J, Zengin A, De Courten B, Ebeling P, Scott D. \u003cstrong\u003eSarcopenia and type 2 diabetes mellitus: a bidirectional relationship\u003c/strong\u003e. 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BMC Musculoskelet Disord. 2019;20(1):276.\u003c/li\u003e\n\u003cli\u003eSmith C, Lewis JR, Sim M, Lim WH, Lim EM, Blekkenhorst LC, Brennan‐Speranza TC, Adams L, Byrnes E, Duque G,et al. \u003cstrong\u003eHigher Undercarboxylated to Total Osteocalcin Ratio Is Associated with Reduced Physical Function and Increased 15\u003c/strong\u003e\u003cstrong\u003e‐\u003c/strong\u003e\u003cstrong\u003eYear Falls\u003c/strong\u003e\u003cstrong\u003e‐\u003c/strong\u003e\u003cstrong\u003eRelated Hospitalizations: The Perth Longitudinal Study of Aging Women\u003c/strong\u003e. J Bone Miner Res.2021;36(3):523-530.\u003c/li\u003e\n\u003cli\u003eMuraca M, Cappariello A. \u003cstrong\u003eThe role of extracellular vesicles (EVs) in the epigenetic regulation of bone metabolism and osteoporosis\u003c/strong\u003e. 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Bone. 2020; \u003cstrong\u003e130\u003c/strong\u003e:115085.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"T2DM, osteocalcin, osteoporosis, sarcopenia, osteosarcopenia","lastPublishedDoi":"10.21203/rs.3.rs-3940392/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3940392/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOsteosarcopenia(OS) has become a global public health problem, which highly influence the life quality for the elderly patients with type 2 diabetes mellitus (T2DM). However, the diagnostic processes is complex and difficult due to lack of the exact diagnostic biomarker. Thus, it is necessary to screen the sensitive biomarker of musculoskeletal metabolism in older patient with T2DM. Previous studies have suggested that osteocalcin mainly involved into the development of musculoskeletal metabolism. This study aimed to investigate the relationship between osteocalcin and osteosarcopenia in elderly patients with T2DM.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eHere we designed a cross-sectional study that included 224 elderly patients with T2DM. We collected the general data and experimental indexes of those patients including bone mineral density (BMD), skeletal muscle index (SMI), grip strength, and gait speed were measured. All subjects were divided into 5 groups based on the above indicators: Controls (CO), Pre-osteosarcopenia(P-OS),Sarcopenia (SP), Osteoporosis(OP), Osteosarcopenia (OS).Meanwhile we examined several bone metabolism-related indexes such as osteocalcin (OC), β-collagen special sequence (β-CTX), and type I procollagen N-terminal propeptide (PINP). Logistic regression analysis was used to analyze the relationship between osteoscarsopenia and osteocalcin.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe results showed the levels of OC, β-CTX, and PINP increased in the osteosarcopenia group. BMD, SMI, handgrip strength and calf circumference decreased with the increasing osteocalcin concentrations (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). A higher serum osteocalcin level was associated with higher risk of OS (OR\u0026thinsp;=\u0026thinsp;10.84, 95% CI (1.24-95.00)) in the logistic regression model.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eOsteocalcin might be used as the important biomarker to predict the risk of OS in elderly type 2 diabetes.\u003c/p\u003e","manuscriptTitle":"Serum Osteocalcin as a Risk Factor for osteosarcopenia in elderly patients with T2DM","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-14 08:56:11","doi":"10.21203/rs.3.rs-3940392/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0871c514-ed27-4983-8dc3-e26b8e11b6e2","owner":[],"postedDate":"February 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-18T08:06:06+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-14 08:56:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3940392","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3940392","identity":"rs-3940392","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}