Purpose/Introduction:​ Conflicting results have been published regarding the effect of abnormal glucose metabolism on osteoporosis (AGM). Fasting glucose is a reliable indicator for abnormal glucose metabolism. Therefore, the aim of present study is to identify the association of fasting glucose level with the risk of incident osteoporosis.

vMethods:​ In a cohort of 59,936 men and 36,690 women (mean age of 63.9 ± 7.1 years) registered in national health insurance database, we assessed the risk of incident osteoporosis according to the quartile levels of baseline fasting glucose (quartile 1:​ <88 mg/dL, quartile 2:​ 88–96 mg/dL, quartile 3:​ 97–107 mg/dL and quartile 4:​ ≥108 mg/dL) and glycemic status categorized into normal, impaired fasting glucose (IFG) and diabetes mellitus (DM). Multivariate Cox-proportional hazard model was used in calculating adjusted hazard ratios (HRs) and 95% confidence interval (CI) for incident osteoporosis (adjusted HRs [95% CI]).

Results:​ Compared with first quartile (reference), the risk of osteoporosis significantly decreased above the fourth quartile in men (second quartile:​ 1.04 [0.91–1.18], third quartile:​ 0.88 (0.76–1.00) and fourth quartile:​ 0.80 [0.70–0.92]) and above third quartile in women (second quartile:​ 0.95 [0.90–1.01], third quartile:​ 0.91 [0.86–0.97] and fourth quartile:​ 0.82 [0.77–0.88]). The risk of osteoporosis was less associated with IFG (men:​ 0.84 [0.76–0.94] and women:​ 0.93 [0.89–0.98]) and DM (men:​ 0.77 [0.65–0.91] and women:​ 0.75 [0.69–0.81]) than normal glucose group in both men and women.

Conclusion:​ Our results suggest that elevated fasting glucose potentially associated with the decreased risk of osteoporosis.

Mini-abstract:​ This retrospective study investigated the association between fasting glucose level and incidence of osteoporosis. Our findings indicate that elevated fasting glucose is significantly associated with the decreased risk of osteoporosis.