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Cell Dev. Biol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with type 2 diabetes mellitus (T2DM) generally present with insulin resistance, central obesity, and increased risk of fragility fracture. But the factors contributing to impaired bone health in T2DM are still unclear. This study investigated the association between the triglyceride glucose index (TyG), a surrogate marker of insulin resistance, and volumetric bone mineral density (vBMD) in T2DM, with a particular focus on the potential role of fat distribution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cross-sectional study, 189 patients with T2DM underwent quantitative computed tomography to assess lumbar vBMD and abdominal fat distribution, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and the visceral-to-subcutaneous fat ratio (VSR). Participants were stratified by TyG tertiles. Spearman correlation analyses, multiple linear regression analyses, and mediation analyses were conducted to examine the associations among TyG, vBMD and fat distribution parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Higher TyG correlated with a worse fat distribution pattern and lower vBMD. In the fully adjusted model, each unit increase in TyG was associated with a 10.420\u00a0mg\/cm\n                      <jats:sup>3<\/jats:sup>\n                      decrease in vBMD (\u03b2: 10.420, 95% CI: 14.476 to \u22126.364,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Mediation analyses demonstrated a statistically significant indirect effect of TyG on vBMD through both VAT and VSR, consistent with a potential intermediary role, with VSR accounting for the largest proportion of the association (32.76%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Elevated TyG is associated with lower vBMD in patients with T2DM, and this association is consistent with a possible indirect link through fat distribution, especially VSR. TyG may serve as a simple and cost-effective marker to identify impaired bone health in T2DM, while targeting unhealthy fat distribution may have potential value in preventing diabetic osteoporosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcell.2026.1811476","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T05:38:07Z","timestamp":1782797887000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of triglyceride glucose index and volumetric bone mineral density in T2DM: fat distribution as a potential indirect link"],"prefix":"10.3389","volume":"14","author":[{"given":"Bei","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Radiology, The Second Xiangya Hospital of Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Jie","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Second Affiliated Hospital of Xinjiang Medical University","place":["\u00dcr\u00fcmqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng-Xin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Second Xiangya Hospital of Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zi-Fei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Second Xiangya Hospital of Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng-Rong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Xiangya Hospital of Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai-Yang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Second Xiangya Hospital of Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling-Qing","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Second Xiangya Hospital of Central South University","place":["Changsha, China"]},{"name":"Department of Radiology Quality Control Center in Hunan Province, Clinical Research Center for Medical Imaging in Hunan Province","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Second Xiangya Hospital of Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s12933-019-0982-2","article-title":"Use of the triglyceride-glucose index (TyG) in cardiovascular disease patients","volume":"19","author":"Alizargar","year":"2020","journal-title":"Cardiovasc Diabetol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"S20","DOI":"10.2337\/dc24-S002","article-title":"2. 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