Osteosarcopenia in Prediabetic Adults Linked to Nearly 3-Fold Higher Osteoarthritis Risk: NHANES Study
China: In a novel analysis of U.S. population data, researchers have uncovered a significant link between osteosarcopenia-a condition marked by both low bone density and reduced muscle mass—and the risk of developing osteoarthritis (OA) in individuals with prediabetes. The findings, published in Scientific Reports by Dr. Shanbin Zheng and colleagues from the Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, shed new light on musculoskeletal complications associated with early metabolic disorders.
The team utilized data from five cycles of the National Health and Nutrition Examination Survey (NHANES), spanning the years 2001 to 2018. Participants included in the study self-reported having OA and had bone mineral density (BMD) and skeletal muscle mass index (SMI) assessed through dual-energy X-ray absorptiometry (DXA).
Using advanced statistical methods, including weighted multinomial logistic regression and restricted cubic splines, the researchers analyzed the relationships between sarcopenia, osteopenia, and their combined manifestation—osteosarcopenia—and the likelihood of OA in adults with prediabetes.
The study led to the following findings:
- Prediabetic individuals were significantly more likely to develop osteosarcopenia than those with normal glucose tolerance.
- Sarcopenia and osteopenia were each independently linked to a higher prevalence of osteoarthritis (OA).
- The coexistence of sarcopenia and osteopenia (osteosarcopenia) further amplified the risk of OA.
- Prediabetic adults with osteosarcopenia had nearly 2.8 times higher odds of developing OA compared to those without these conditions.
- There was a strong association between skeletal muscle mass index and bone mineral density in the prediabetic group.
- Prediabetic individuals had 1.3 to 1.6 times greater odds of having sarcopenia and osteopenia than those with normal glucose metabolism.
While the large sample size and national representation of NHANES enhance the study’s reliability, the authors acknowledged several limitations. These include reliance on self-reported OA diagnosis without imaging confirmation, absence of stratification between osteopenia and osteoporosis due to limited subgroup sizes, and the cross-sectional nature of the data, which precludes causal inference.
Despite these constraints, the research marks an important step in identifying at-risk populations. “Our findings suggest that in individuals with prediabetes, preventing or managing osteosarcopenia could be key to reducing OA risk,” the authors noted. They also emphasized the importance of targeted interventions, especially in prediabetic patients undergoing total joint arthroplasty (TJA), who may benefit from focused perioperative care, muscle-strengthening regimens, and bone-protective treatments.
"Our study highlights the emerging role of osteosarcopenia in the development of osteoarthritis among prediabetic adults and underscores the need for integrated musculoskeletal and metabolic health strategies to mitigate future joint degeneration in this population," the authors concluded.
Reference:
Zheng, S., Shao, L., Zhu, J., Sun, J., Chen, Z., Cao, X., Zhang, C., Xia, T., & Shen, J. (2025). Exploring the link between osteosarcopenia and osteoarthritis in prediabetic adults using NHANES data. Scientific Reports, 15(1), 1-12. https://doi.org/10.1038/s41598-025-95344-9
