1436-P: Diabetic Neuropathy-Osteopenia Axis: 78% Prevalence of Peripheral Neuropathy with 60-71% Concurrent Bone Loss across Severity Grades—A Novel Neuro-Skeletal Comorbidity Pattern

Introduction and Objective: Diabetic neuropathy and osteopenia share common pathophysiological mechanisms yet their co-occurrence has not been systematically quantified. We hypothesized that neuropathy severity correlates with bone mineral density loss. This study quantified the magnitude of neuropathy-osteopenia comorbidity. Methods: We analyzed 120 adults with type 2 diabetes with (DEXA) bone mineral density measurement. Neuropathy severity was determined by neurological examination including vibration perception, monofilament testing, and ankle reflexes. Bone health was classified as normal, osteopenia (T-score -1.0 to -2.5), or osteoporosis (T-score <-2.5). We calculated prevalence of neuropathy by severity grade, cross-tabulated neuropathy status with bone health and compared metabolic parameters Results: Overall neuropathy prevalence was remarkably high at 78.3% (94/120), with mild 43.3%, moderate 2.5%, severe 32.5% and normal 21.7%. Among 118 patients with concurrent bone density data, bone abnormalities were pervasive: 63.0% had osteopenia or osteoporosis. Critically, neuropathy-osteopenia comorbidity exhibited a severity-dependent pattern: patients with severe neuropathy had 59.5% osteopenia prevalence, mild neuropathy 71.2%, moderate neuropathy 100% while those without neuropathy had only 42.3% (11/26) bone loss. Conclusion: This study reveals that diabetic peripheral neuropathy is not an isolated complication but part of a neuro-skeletal disease axis, with 78% overall neuropathy prevalence and 60-71% concurrent bone loss across severity grades. More critically, 60-100% of neuropathy patients have concurrent osteopenia, creating a dual-risk phenotype for catastrophic falls and fractures: impaired sensation preventing fall avoidance (neuropathy) combined with fragile bones prone to fracture (osteopenia). Disclosure S. Singla: None. B. Makkar: Speaker's Bureau; Current; Lilly, Novo Nordisk. Advisory Panel; Current; USV Private Limited. A. Maheshwari: None. S. Patil: None. A. Bishnoi: None. A. Raha: None. S.D. Sonawala: None. R. Viegas: None. K. Soota: None.