Objective To explore the correlation between insulin resistance and bone  mineral density (BMD) and bone microstructure in adult males.

Methods Chinese adult males who underwent examinations in the department of geriatric endocrinology of the First Affiliated Hospital with Nanjing Medical University from January 2018 to July 2021 were retrospectively selected as study subjects. The results of oral glucose tolerance tests, BMD, and trabecular bone score (TBS) were collected. Indices such as homeostasis model assessment of β-cell function (HOMA-β), homeostasis model assessment of insulin resistance (HOMA-IR), and the Matsuda index were calculated using a steady-state model. Multiple linear regression analysis was used to explore the correlation between metabolic-related indicators and BMD, TBS.

Results A total of 283 adult males were included. Body mass index (BMI) (r=0.279, P < 0.001), fasting insulin level (r=0.174, P=0.003), HOMA-IR (r=0.184, P=0.002) was all positively correlated with BMD, but the Matsuda index was negatively correlated with BMD (r=-0.157, P=0.008). Low-density lipoprotein cholesterol (r=-0.136, P=0.022), HOMA-β (r=-0.140, P=0.018), and HOMA-IR (r=-0.160, P=0.007) were negatively correlated with TBS, while the Matsuda index was positively correlated with TBS (r=0.156, P=0.009). Multiple linear regression analysis showed that after adjusting for age, BMI, and blood lipid indicators, while the correlation between HOMA-IR and Matsuda index with BMD disappeared (P > 0.05); HOMA-IR was still negatively associated with TBS (β=-0.143, P=0.039), and Matsuda index was still positively associated with TBS (β=0.142, P=0.035).

Conclusion The aggravation of insulin resistance and the decrease in insulin sensitivity are not related to changes in BMD, but can lead to bone microstructure destruction and increased bone fragility.

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