Physiological and Hormonal Predictors of Bone Loss in Male Adults with Type 2 Diabetes Mellitus in Nnewi, Anambra State, South East Nigeria

Background: Type 2 diabetes mellitus is paradoxically associated with elevated fracture risk despite normal or high bone mineral density, suggesting that bone quality rather than density is the primary determinant of diabetic skeletal fragility. Hormonal mechanisms including insulin-like growth factor-1 suppression, advanced glycation end-product accumulation, and sclerostin elevation mediate this bone quality deficit. Empirical data addressing hormonal predictors of bone loss in Nigerian male diabetics are absent. Objectives: This study aims to measure bone mineral density by dual-energy X-ray absorptiometry, serum sclerostin, osteocalcin, insulin-like growth factor-1, and parathyroid hormone as markers of bone metabolism in male adults with type 2 diabetes compared with age-matched normoglycaemic controls at Nnamdi Azikiwe University Teaching Hospital, Nnewi. Methods: Sixty male type 2 diabetic adults and thirty normoglycaemic controls aged 40 to 65 years will be recruited. Hormonal assays will be performed by ELISA on fasting morning serum samples. Dual-energy X-ray absorptiometry will assess lumbar spine and femoral neck bone mineral density. Glycated haemoglobin, serum calcium, phosphate, and vitamin D will be measured. Multiple regression will identify independent hormonal predictors of bone mineral density and bone turnover marker status. Expected Outcomes: Diabetic men are anticipated to exhibit elevated sclerostin, suppressed osteocalcin, and reduced insulin-like growth factor-1 despite comparable or higher bone mineral density, with sclerostin emerging as the dominant predictor of bone quality impairment. Conclusion: Findings will illuminate the hormonal physiological basis of skeletal fragility in Nigerian male diabetics and support targeted bone health monitoring. Keywords: type 2 diabetes, bone mineral density, sclerostin, osteocalcin, Nnewi.