Relationship between neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio and osteoporosis in postmenopausal type 2 diabetic patients: A retrospective study

Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR) are newly discovered inflammatory markers in recent years. To explore the relationship between NLR, MLR, PLR, and bone mineral density (BMD), as well as osteoporosis (OP), in postmenopausal patients with type 2 diabetes mellitus (T2DM). 320 postmenopausal patients with T2DM who were admitted to the Department of Endocrinology and Metabolic Diseases of our hospital from January 2022 to January 2024 for treatment were included in this retrospective study. The patients were divided into 3 groups according to the BMD: normal bone mass group (n = 109), osteopenia group (n = 99), and OP group (n = 112). Clinical data and blood laboratory parameters were collected from the patients. The NLR, MLR, and PLR were calculated. Statistically significant differences were found in the comparison of NLR, MLR, and PLR among the 3 groups of patients (P < .001). The OP group had higher NLR, MLR, and PLR than the normal bone mass group and the osteopenia group. NLR, MLR, and PLR were negatively correlated with BMD at the lumbar spine (L1-L4), left femoral neck, and left hip, respectively. Analysis revealed that elevated levels of NLR and PLR were independent risk factors for OP in postmenopausal patients. The results of the receiver operating characteristic curve analysis indicated that the area under the curve (AUC) for NLR was higher than that of PLR. Combined use of NLR and PLR resulting in an improved AUC of 0.904. Neutrophils produce mediators such as interferon-gamma (IFN-γ), interleukin-6 (IL-6), interleukin-1 (IL-1), and receptor activator of nuclear factor kappa-B ligand (RANKL), which increase the number and activity of osteoclasts. Peripheral blood monocytes play a vital role in osteoclastogenesis as osteoclast precursors. The BMD of postmenopausal T2DM patients is negatively correlated with NLR, MLR, and PLR. NLR and PLR can both serve as predictive indicators for the occurrence of OP in postmenopausal T2DM patients.