Diagnostic accuracy of serum miR-23a-3p, miR-150, and miR-150-5p for diabetic osteoporosis in adults with type 2 diabetes: a retrospective single-center cohort study

BACKGROUND: Diabetic osteoporosis (DOP) is a frequently under-recognized complication of type 2 diabetes (T2D). This study evaluated the association and diagnostic performance of serum miR-23a-3p, miR-150, and miR-150-5p for identifying DOP in adults with T2D. METHODS: A single-center retrospective cohort included 225 adults with T2D (DOP, n = 57; non-DOP, n = 168). Serum microRNAs were quantified by qRT-PCR. Independent associations with DOP were assessed using multivariable logistic regression. Discrimination was evaluated by ROC analysis for each miRNA and a combined model, and calibration was examined. RESULTS: Compared with the non-DOP group, the DOP group was older, had a longer diabetes duration, and had higher fasting plasma glucose and HbA1c (all P < 0.05). Serum miR-23a-3p, miR-150, and miR-150-5p levels were higher in DOP (all P < 0.001) and remained independently associated with DOP (miR-23a-3p: OR 3.71; miR-150: OR 5.32; miR-150-5p: OR 9.57). The AUCs were 0.77 (miR-23a-3p), 0.88 (miR-150), and 0.80 (miR-150-5p). The combined model achieved an AUC of 0.95 with 0.95 sensitivity and 0.82 specificity, with good calibration. CONCLUSIONS: Serum miR-23a-3p, miR-150, and miR-150-5p were independently associated with DOP, and their combined assessment showed excellent diagnostic discrimination. External validation and analytical standardization are required before this panel can be considered for clinical application.