Scientometric analysis of global publications on prediabetes and osteoporosis: 1994–2023

Abstract

Background and aims

Prediabetes and osteoporosis are two commonly prevalent diseases that can have interconnected implications for overall well-being. There is a paucity of literature on “prediabetes and osteoporosis”. We aimed to assess the current state of cross-sectional studies involving osteoporosis and prediabetes as well as their bibliometric features.

Methods

Publications about prediabetes and osteoporosis between January 1994 and November 2023 were taken from the Scopus database, and VOSviewer and Microsoft Office Excel were used for bibliometric analysis and visualization.

Results

We identified 272 documents that were written by 531 authors from 48 countries including 252 organizations. The USA was the leading country with the highest publications (n = 84) and Canada had the largest citation impact per paper (109.0). University of California, San Francisco contributed the most publications (n = 6), while Universita degli Studi di Torino, Italy (275.0 and 5.25), had the highest citation impact. Frontiers in Endocrinology (n = 7), was the most productive journal, while Annals of Internal Medicine (322.0) was the most influential in terms of citation impact per paper. The funded research was 30.5 %, while 17.6 % of research were involved in international collaboration.

Conclusion

The number of publications on this topic has increased over three decades. The highest citations per paper were received by the publications which had external funding, followed by those which had international collaboration. All the highly cited papers were published from high-income countries.

Highlights

• •A total of 272 publications were found on prediabetes and osteoporosis from 1994 to 2023.
• •The number of publications on this topic has increased over three decades.
• •The highest citations per paper were received by publications with external funding, and international collaboration.
• •All the highly cited papers were published from high-income countries.

1. Introduction

Osteoporotic bones are susceptible to fractures due to deterioration of their microarchitecture leading to increased bone fragility.¹ It is estimated in the literature that around 54 million Americans suffer from osteoporosis or have low bone mass in the lumbar spine and femur neck.² The high prevalence of osteoporosis and the resulting fractures pose a significant medical burden and are emerging as a major public health concern.³

Furthermore, there is a substantial economic burden associated with the epidemic of glucose metabolism disorders, which was projected to cost the United States nearly $404 billion in 2017.⁴ Prolonged elevation of blood sugar levels, including diabetes and other related conditions, adversely affects bone health and is believed to be a complication of poorly regulated glucose metabolism.^5,6 Prediabetes, an intermediate metabolic state between normal blood sugar levels and diabetes, encompasses impaired fasting plasma glucose (FPG), impaired glucose tolerance, and slightly elevated levels of glycosylated haemoglobin A1c (HbA1c). According to recent data, persons with prediabetes may be more susceptible than those with normal blood sugar levels to complications related to diabetes.⁷ Several complications are known to be associated with prediabetes, including increased risk of all-cause mortality, cardiovascular disease, stroke, cardiovascular heart failure, chronic kidney disease, and some cancers,⁸ however, bone has been less investigated.

Prediabetes and osteoporosis are two commonly prevalent diseases that can have interconnected implications for overall well-being. There is a paucity of literature on “prediabetes and osteoporosis”. This prompted us to undertake the present bibliometric study to provide a summary of the global research done in this area and to identify the hotspots and frontiers of research on this topic.

2. Methods

Publications on the theme “Prediabetes and Osteoporosis” were identified and retrieved using a pre-defined search strategy from the Scopus database on December 19, 2023. The search strategy involved the use of two sets of keywords related to ‘prediabetes’ and ‘osteoporosis’ with the help of boolean operators, as follows:

((KEY (prediabet*) OR KEY (“impaired glucose tolerance”) OR KEY (“impaired fasting glucose”))) AND KEY (osteoporosis) AND (LIMIT-TO (EXACTKEYWORD, “Osteoporosis”)).

The search retried 272 total records, which were further analyzed with the help of additional analysis features in the Scopus database. Data analysis and visualization were conducted using Microsoft Excel and VOSviewer. In the networking map, each node represents an individual author, institution or journal, with node size proportional to the number of connections established through citations. The lines interlinking the nodes signify the citation connections existing between them, and the line thickness corresponds to the quantity of citation connections attributed to each of them.

Several select quantitative and qualitative indicators were used to measure the performance of research in this area. The most productive authors and institutions were those with the higher number of publications and the most impactful were those with the higher citation impact, as measured by the citation per paper (CPP), and relative citation index (RCI). The highly-cited papers (HCP) were considered as those which received more than 100 citations each.

3. Results

3.1. Overall results

In all 272 papers were published on “Prediabetes and Osteoporosis” during the last three decades. The 10-year cumulative publications during 1994–2003 increased from 19 to 95 publications during 2004–2013 and to 158 publications during 2014–2023. These publications received 14243 citations, averaging 52.36 CPP.

A total of 83 publications, accounting for 30.51 % of the total, received external funding support. These publications garnered a total of 7820 citations, with an average of 94.21 citations per publication. The leading funding agencies that supported research in this field were the National Institute of Health (13 publications), National Institute of Diabetes and Digestive and Kidney Diseases (9 publications), National Natural Science Foundation of China (9 publications), National Center for Research Resources and U.S. Department of Health & Human Service (5 publications each), American Diabetes Association, National Center for Advanced Translational Sciences, National Health & Medical Research Council, National Heart, Lung & Blood Institute, and National Institute of Aging (4 publications each), among others. Only 48 papers, representing 17.65 % of the total, were involved in international collaboration. These papers collectively received 3064 citations, with an average of 63.83 CPP.

The maximum publications (50.74 %; n = 138) appeared as research articles, and reviews (36.03 %; n = 98) and in English (98.16 %; n = 267).

3.2. Leading countries

In all 48 countries participated in these papers; 29 countries contributed 1–5 papers each, 9 countries 6–10 papers, 9 countries 11–50 papers and 1 country 84 papers. Four countries contributed more than the average productivity (22.67) of all 12 countries including the USA (n = 84), Italy and United Kingdom (UK) (n = 33) and China (n = 25). Four countries (Canada, USA, UK, and Italy) registered citation impact, above the average (70.72 and 1.35) of all 12 countries (Table 1).

Table 1.

Bibliometric profile of the 12 most productive countries.

S. No.	Country	TP	TC	CPP	RCI	HI	ICP	%ICP	TLS	TLS-WN
1	United States of America	84	8054	95.88	1.83	32	26	30.95	58	35
2	Italy	33	2676	81.09	1.55	14	14	42.42	55	23
3	United Kingdom	33	2789	84.52	1.61	19	12	36.36	39	22
4	China	25	326	13.04	0.25	9	6	24.00	18	12
5	Japan	16	1022	63.88	1.22	10	1	6.25	1	0
6	Australia	15	1016	67.73	1.29	10	7	46.67	9	4
7	Germany	13	912	70.15	1.34	10	8	61.54	32	23
8	India	12	114	9.50	0.18	5	3	25.00	12	11
9	Netherlands	12	643	53.58	1.02	9	8	66.67	23	11
10	Canada	11	1199	109.00	2.08	5	5	45.45	17	14
11	Belgium	9	393	43.67	0.83	7	6	66.67	14	8
12	Turkey	9	91	10.11	0.19	4	5	55.56	21	9
		272	19235	70.72	1.35	134	101	37.13	299	172
		272	14243	52.36	1.00
		84	8054	95.88	1.83	32	26	30.95	58	35

(TP: Total Publications; TC: Total Citations; CPP: Citations Per Paper; HI: H-Index; ICP: International Collaborative Papers; TLS: Total Link Strength; TLS-WN = Total link strength within the network).

3.3. Collaborative network among countries

A collaborative network visualization map among the top 20 countries with 5 or more publications was constructed with the help of the VIER network (Fig. 1). Among the top 20 countries, the USA depicted the largest total link strength (TLS) (n = 58), followed by Italy (n = 55), the UK (n = 39), Germany (n = 32), the Netherlands (n = 23), Turkey (n = 21), etc. The largest collaborative linkages (35) within the collaborative network were depicted by the USA, followed by Italy and Germany (n = 23 each), the U.K. (n = 22), Canada (N = 14), China (n = 12), India and Netherlands (n = 11 each), etc. In Fig. 1, the top 20 countries are depicted in five clusters, forming 94 links with a TLS of 169. Cluster 1 encompasses 7 countries: the USA, Italy, India, Canada, France, Israel, and Switzerland. Cluster 2, represented in green, includes 6 countries: China, Germany, Turkey, Greece, Spain, and Poland. Cluster 3 is composed of 5 countries: the UK, Netherlands, Belgium, Denmark, and Iran. Lastly, Clusters 4 and 5 are represented by individual countries: Australia and Japan, respectively.

Fig. 1.

Network visualization of the top 20 countries, each with a minimum contribution of five articles, showing maximum influence of the United States, followed by the United Kingdom.

3.4. Leading organizations

In all 252 organizations participated in 272 global papers, with the top 20 organizations individually contributing 3 to 6 papers (Table 2). Together these 20 organizations contributed 87 papers and received 7708 citations, accounting for 31.99 % of the global publications and 54.12 % share of the citations. Five countries contributed more than the average productivity (4.35) of all 20 organizations. These include University of California (USA), University of Melbourne (Australia) and Universita degli Studi di Milano (Italy), (n = 6 each), Brigham & Women's Hospital (USA) and John Hopkins School of Medicine (USA) (n = 5 each). Nine organizations registered citation impact above the average (88.6 and 1.69) of all 20 organizations and include Universita degli Studi di Torino, Italy (275.0 and 5.25), Universita degli Studi di Milano, Italy 195.0 and 3.72), John Hopkins School of Medicine, USA (190.6 and 3.64), University of California, Los Angles, USA (179.0 and 3.42), University of Tokyo, Japan (173.5 and 3.31), Tokyo Women's Medical University, Japan (148.75 and 2.84), Erasmus MC, Netherlands (119.0 and 2.27), Leids Universitair Medisch Centrum, Netherlands (100.0 and 1.91) and University of California, USA (97.83 and 1.87).

Table 2.

Bibliometric profile of the 20 most productive organizations.

S. No.	Organization	TP	TC	CPP	RCI	HI	ICP	%ICP	TLS	TLS-WN
1	University of California, San Francisco, USA	6	587	97.83	1.87	4	3	50.00	54	1
2	University of Melbourne, Australia	6	91	15.17	0.29	5	2	33.33	26	10
3	Universita degli Studi di Milano, Italy	6	1170	195.00	3.72	5	2	33.33	28	5
4	Brigham & Women's Hospital, USA	5	26	5.20	0.10	3	0	0.00	16	3
5	John Hopkins School of Medicine, USA	5	953	190.60	3.64	4	1	20.00	17	1
6	Harvard Medical School, USA	4	352	88.00	1.68	2	1	25.00	21	4
7	Fondazione ITCCS Ca Granda Ospedale Maggiore Policlinico, Italy	4	84	21.00	0.40	3	1	25.00	6	5
8	UNiversita degli Studi di Torino, Italy	4	1100	275.00	5.25	4	2	50.00	25	2
9	Icahn School of Medicine at Mount Sinai, USA	4	69	17.25	0.33	2	2	50.00	9	0
10	Leids Universitair Medisch Centrum, Netherlands	4	400	100.00	1.91	3	3	75.00	22	2
11	Universita degli Studi di Napali Federici 11, Italy	4	105	26.25	0.50	4	2	50.00	24	2
12	Deakin University, Australia	4	76	19.00	0.36	4	2	50.00	20	10
13	Monash University, Australia	4	57	14.25	0.27	3	2	50.00	12	6
14	Barwon Health, Australia	4	76	19.00	0.36	4	2	50.00	20	10
15	University of Tokyo, Japan	4	694	173.50	3.31	4	0	0.00	3	1
16	Tokyo Women's Medical University, Japan	4	595	148.75	2.84	4	0	0.00	25	1
17	University of California, Los Angeles, USA	4	716	179.00	3.42	4	2	50.00	37	3
18	National and Kapodistrian University of Athens, Greece	4	27	6.75	0.13	3	3	75.00	49	1
19	Erasmus MC, Netherlands	4	476	119.00	2.27	4	2	50.00	16	2
20	Klinikum Munchen Universitat Munchin, Germany	3	54	18.00	0.34	3	0	0.00	7	0
		87	7708	88.60	1.69	72	32	36.78	437	66
		272	14243	52.36	1.00
		31.99	54.12

(TP: Total Publications; TC: Total Citations; CPP: Citations Per Paper; HI: H-Index; ICP: International Collaborative Papers; TLS: Total Link Strength; TLS-WN = Total link strength within the network).

The TLS of the top 20 organizations varied from 3 to 54, with highest (n = 54) collaborative linkages depicted by the University of California, San Francisco, USA, followed by National and Kapodistrian University of Athens, Greece (n = 49), University of California, Los Angles, USA (n = 37), Universita degli Studi di Milano, Italy (n = 28), University of Melbourne, Australia (n = 26), Universita degli Studi di Torino, Italy and Tokyo Women's Medical University, Japan (n = 25 each), etc. But if we collaborative linkages among the top 20 organizations, the University of Melbourne, Australia, Deakin University, Australia and Barwon Health, Australia depicted the largest number of collaborative linkages (n = 10 each), followed by Monash University, Australia (n = 6), Universita degli Studi di Milano, Italy and Fondazione ITCCS Ca Granda Ospedale Maggiore Policlinico, Italy (n = 5 each), Harvard Medical School, USA (n = 4), etc. In terms of organization-to-organization collaborative linkages, the largest (4 each) were depicted by organizational pairs such as: “University of Melbourne, Australia and Deakin University, Australia”, “University of Melbourne, Australia and Barwon Health, Australia” and “Universita degli Studi di Milano, Italy and Fondazione ITCCS Ca Granda Ospedale Maggiore Policlinico, Italy”, etc.

3.5. Leading authors

In all, 531 authors participated in 272 global papers. Among them, the top 20 authors individually contributed 2 to 4 papers (Table 3). Together these 20 authors contributed 56 papers and 4867 citations, accounting for 20.59 % and 34.17 % share of the global publications and citations. Thirteen authors contributed more than the average productivity (2.8) of all 20 authors and include V. De Sanctis, M.A.Kotowicz and J.A. Pasco (4 papers each), M.Baldini, M.D.Cappellini, H.Elsedfy Ain Shams, D.G. Goulis, K.L. Holloway-Kew, A.Marcon, M.A. Sajjad, F.M.Ulivieri, B. Anton and G. Arnaldi(3 papers each). Four authors registered citation impact, measured by citation per paper (CPP) and relative citation index (RCI) above the average (86.91 and 1.66) of all 20 authors and include M.Boscaro (572.00 and 10.92), A.B.Atkinson (543.0 and 10.37), G. Arnaldi (381.0 and 7.28) and B. Anton (228.33 and 4.36).

Table 3.

Bibliometric profile of the 20 most productive authors.

S. No.	Author	Affiliation	TP	TC	CPP	RCI	HI	ICP	%ICP	TLS	TLS-WN
1	V. De Sanctis	Ain Shams University, Egypt	4	20	5.00	0.10	3	3	75.00	30	3
2	M.A. Kotowicz	Deakin University, Australia	4	76	19.00	0.36	4	2	50.00	21	10
3	J.A. Pasco	Deakin University, Australia	4	76	19.00	0.36	4	2	50.00	21	10
4	M. Baldini	Fondazione ITCCS Ca Granda Ospedale Maggiore Policlinico, Italy	3	84	28.00	0.53	3	0	0.00	21	11
5	M.D. Cappellini	Fondazione ITCCS Ca Granda Ospedale Maggiore Policlinico, Italy	3	84	28.00	0.53	3	0	0.00	21	11
6	H. Elsedfy	Ain Shams University, Egypt	3	14	4.67	0.09	2	3	100.00	27	3
7	D.G. Goulis	Aristotle University of Thessaloniki, Greece	3	25	8.33	0.16	2	1	33.33	24
8	K.L. Holloway-Kew	Deakin University, Australia	3	42	14.00	0.27	3	1	33.33	15	5
9	A. Marcon	Fondazione ITCCS Ca Granda Ospedale Maggiore Policlinico, Italy	3	84	28.00	0.53	3	0	0.00	21	8
10	M.A. Sajjad	Daakin University, Australia	3	61	20.33	0.39	3	1	33.33	15	3
11	F.M. Ulivieri	Fondazione ITCCS Ca Granda Ospedale Maggiore Policlinico, Italy	3	84	28.00	0.53	3	0	0.00	21	11
12	B. Anton	John Hopkins School of Medicine, USA	3	685	228.33	4.36	2	0	0.00	12
13	G. Arnaldi	Universita Politecnica della Marche, Italy	3	1143	381.00	7.28	2	1	33.33	23	2
14	A.B. Atkinson	Royal Victoria Hospital, Belfast, UK	2	1086	543.00	10.37	2	1	50.00	20
15	M. Bidlingmaier	Klinkum der Universitat Munchen, Germany	2	26	13.00	0.25	2	0	0.00	13
16	T. Bloomgarden	Icahn School of Medicine at Mount Sinai, USA	2	4	2.00	0.04	2	0	0.00	0
17	M. Bolanowski	Wroclaw Medical University, Poland	2	13	6.50	0.12	1	0	0.00	12
18	M. Boscaro	Universita Politecnica delle Marche, Italy	2	1144	572.00	10.92	2	1	50.00	23	2
19	T. Brue	Air Marseille Universite, France	2	75	37.50	0.72	2	1	50.00	14
20	R. Cassin	Fondazione ITCCS Ca Granda Ospedale Maggiore Policlinico, Italy	2	41	20.50	0.39	2	0	0.00	13
			56	4867	86.91	1.66	50	17	30.36	367	79
			272	14243	52.36	1.00
			20.59	34.17

(TP: Total Publications; TC: Total Citations; CPP: Citations Per Paper; HI:H-index; ICP: International Collaborative Papers; TLS: Total Link Strength; TLS-WN = Total Link Strength within the Network).

The TLS of the top 20 authors varied from 0 to 30, with a maximum (30) reported by V. De Sanctis, followed by H.Elsedfy (n = 27), D.G. Goulis (n = 24), G. Arnaldi and M.Boscaro (n = 23 each), M.A.Kotowicz, J.A. Pasco, M.Baldini, M.D.Cappellini, A. Marcon and F.M.Ulivieri (n = 21 each), etc. In terms of author-to-author collaborative linkages, the largest number of linkages were made by author pair such as “M.A.Kotowicz and J.A. Pasco”, followed by “V.De Sanctis and H. Elsedfy”, “M.A.Kotowicz and M.A.Sajjad”, “J.A.Pasco and K.L.Holloway-Kew”, “M.A.Kotowicz and K.L.Holloway-Kew”, “M.Baldini and M.D.Cappellini” (n = each).

Fig. 2 presents a network visualization depicting the top 20 authors who have contributed a minimum of 2 articles each, resulting in their categorization into 10 clusters. These clusters collectively form 20 links with a total link strength of 51. Cluster 1, highlighted in red, comprises five authors: Baldini M., Cappellini M.D., Cassin R., Marcon A., and Ulivieri F.M. Cluster 2, delineated in green, consists of four authors: Holloway-Kew K.L., Kotowicz M.A., Pasco J.A., and Sajjad M.A. Meanwhile, Cluster 3, represented in yellow, encompasses three authors: Arnaldi G., Atkinson A.B., and Boscaro M. Additionally, Cluster 4, marked in purple, includes two authors: De Sanctis V. and Elsedfy H. Lastly, Clusters 5 to 10 each consist of a single author.

Fig. 2.

Network visualization map of the top 20 co-authorships based on the Total Link Strength.

3.6. Leading journals

Of the 272 papers, 269 appeared in journals, 3 in book series and 1 as a book. The 269 journal papers appeared in 210 journals, of which 176 journals published 1 paper each, 21 journals 2 papers each, 8 journals 3 papers each, 1 journal 4 papers, 2 journals 5 papers each, and 1 journal each 6 and 7 papers. The top 20 journals individually published 2 to 7 papers each (Supplement 1). Together these 20 journals contributed 65 papers and 5525 citations, accounting for 23.9 % and 38.79 % share in global publications and citations. Among the top 20 journals, the top 5 most productive journals were: Frontiers in Endocrinology (n = 7), Journal of Clinical Endocrinology & Metabolism (n = 6), Diabetes Care, and Journal of Endocrinological Investigation (n = 5 each) and Calcified Tissue International (n = 4). The top 5 most impactful journals in terms of CPP were Annals of Internal Medicine (322.0), Orphanet Journal of Rare Diseases (313.33), Journal of Clinical Endocrinology & Metabolism (305.0), Diabetes Care (123.0) and Current Osteoporosis Reports (118.0).

Supplement 2depicts a citation networking map encompassing the top 20 journals, each having at least two publications. These 20 journals have been segregated into 13 clusters, forming a network with 9 links and a combined link strength of 12.

3.7. Broad subject-wise distribution

According to the Scopus subject categories, the literature is classified in five broad subjects, with maximum contribution (92.65 %) coming from “Medicine”, followed by “Biochemistry, Genetics & Molecular Biology” (29.41 % share), “Pharmacology, Toxicology & Pharmaceutics” (5.15 % share), “Immunology & Microbiology” (2.20 % share) and “Neuroscience” (1.84 % share). In terms of citation impact per paper (CPP). Medicine registered the highest citation impact (54.31), followed by Biochemistry, Genetics & Molecular Biology”(50.76), “Pharmacology, Toxicology & Pharmaceutics” (37.0), “Immunology & Microbiology” (19.33) and “Neuroscience” (17.2).

3.8. Significant keywords

The 272 papers contained 2675 keywords, of which 168 keywords have a frequency of occurrence of more than 12. The top 8 most important keywords in terms of frequency of occurrence were: “Osteoporosis” (n = 272), “Impaired Glucose Tolerance” (n = 264), “Diabetes Mellitus”(n = 124), “Hypertension” (n = 105), “Obesity” (n = 91), “Non Insulin Dependent Diabetes Mellitus”(n = 76), “Bone Density” (n = 74), and “Insulin Resistance” (n = 54) (Supplementary Table 1). A Network Visualization of the Co-occurrence Map of the Top 77 significant Keywords is presented in Fig. 3.

Fig. 3.

Network visualization of Co-occurrence map of the top 77 significant keywords.

The co-occurrence map displays the distribution of the top 76 most significant keywords into four clusters, represented by the colours red, green, blue, and yellow, as depicted in Supplement 3. These keywords collectively exhibit 2321 links and a total link strength of 11643. Cluster 1, marked in red, incorporates 25 interconnected keywords that encompass a wide range of medical conditions, medications, symptoms, and treatments, showcasing interconnectedness across diverse health domains. Cluster 2, identified in Blue, is composed of 23 keywords primarily focused on diabetes mellitus, metabolic health, bone density, and cardiovascular risks, illustrating interconnections between diabetes management, bone health, and cardiovascular influences. Cluster 3, highlighted in Blue as well, comprises 15 keywords primarily associated with endocrine disorders, bone health, hormonal factors, and metabolic disorders and emphasises the complexity of hormonal health's impact on physiological functions. Lastly, Cluster 4, depicted in Yellow, consists of 13 keywords primarily associated with a range of cardiovascular health, obesity-related concerns, mental health, and associated diseases, showcasing the intricate relationship between lifestyle factors, obesity, mental health, and various cardiovascular conditions, highlighting the importance of lifestyle modifications in disease management and prevention.

3.9. Highly-cited papers

Twenty-four HCPs (8.82 %) received a maximum of 2241 citations to a minimum of 101 citations. These 24 HCPs which together received 10030 citations, averaging 417.92 CPP. Among these HCPs, five were from a single organization (zero collaboration) and 19 were involved in collaboration with two or more organizations. These HCPs were published in 21 journals, of which the Journal of Clinical Endocrinology published a maximum of three papers and the rest were published with one paper each in other journals.

4. Discussion

Our research found a total of 272 publications in the Scopus database on ‘prediabetes and osteoporosis’ from 1994 to 2023. We noticed an increasing trend of publications on this topic over three decades from only 19 in the 1st decade (1994–2003) to 158 in the 3rd decade (2024-2023). The highest CPPs were received by publications with had external funding (94.21), followed by those which had international collaboration (63.83), as compared to an average CPPof all the papers (52.36). There were 24 HCPs, accounting for 8.82 % of the total publications. These HCPs received citations from 101 to 2241, with an average CPP of 417.92, and all the HCPs were published from high-income countries (HIC). Out of all 24 HCPs, the majority (n = 19) were ICPs, signifying the importance of research collaboration in producing high-impact research and publications, as it helps in fostering the exchange of diverse ideas, expertise, and resources. Therefore, collaborative studies enable to provide a broader pool of knowledge and help address global challenges through collective efforts.^{9, 10, 11} We believe that such global studies contribute to the advancement of science. Research funding is also crucial in fostering Innovations, and helps in driving scientific advancements. Without adequate research funding, the progress of scientific discoveries and technological breakthroughs would be severely hampered.^11,12 In line with our findings, the research that received funding demonstrated higher citation metrics and altmetrics, suggesting that the impact of the research goes beyond its quantity. This indicates that funding plays a role in enhancing both the quality and dissemination of research.¹³ A recent study has provided comprehensive knowledge about the pathogenesis and clinical management of bone fragility in diabetes.^14,15 However, the impact of prediabetes on the skeleton remains largely unknown. Despite the growing evidence, the relationship between osteoporosis and prediabetes is not straightforward. Elevated blood sugar levels in prediabetes have been associated with reduced bone turnover and bone mineral density.

Hyperglycemia and insulin resistance are thought to contribute to functional changes in bone cells and marrow fat, which affect various factors related to bone strength.¹⁶ It is widely acknowledged that older individuals and those who are overweight have a higher prevalence of prediabetes, which not only increases the risk of developing Type 2 diabetes (T2D) but also leads to cardiovascular complications. Napoli et al.⁷ demonstrated an increased risk of fragility fractures in patients with both type 1 diabetes (T1D) and T2D, with decreased bone mineral density (BMD) in T1D and normal BMD in T2D compared to a control group of the same age. However, in both T1D and T2D, there is a decrease in bone turnover and alterations in bone microstructure. The underlying mechanisms responsible for bone fragility in diabetes are complex. These factors may be linked to hyperglycemia, oxidative stress, and the accumulation of advanced glycation end products. These factors can impair collagen properties, increase the buildup of fat in the bone marrow, release inflammatory factors and adipokines from visceral fat, and disrupt the function of bone cells.⁷ Additionally, the risk of fractures in patients with diabetes is also influenced by treatment-related hypoglycemia, direct side effects of certain medications like thiazolidinediones on bone and mineral metabolism, and an increased susceptibility to falling.

In a research conducted in the United States, a group of 1690 women, 225 women (13.3 %) had prediabetes before reaching menopause, while 1465 women (86.7 %) did not have prediabetes before this transition. Among those with prediabetes, 11.1 % experienced a fracture, whereas only 7.6 % of women without prediabetes sustained a fracture. These results suggest that women in midlife with prediabetes face an elevated risk of fractures. It would be advantageous to investigate whether treating prediabetes can help mitigate the risk of fractures.¹⁷ A controlled, observational, cross-sectional study carried out in Turkey involved 120 post-menopausal women and men over the age of 65, out of which 90 were prediabetic and 30 served as controls. Approximately one-fourth of these prediabetic women were found to have osteoporosis.¹⁸ Hence, it is crucial to assess bone mineral density (BMD) when evaluating individuals with prediabetes.

Despite its significance, there is a lack of bibliometric analyses on prediabetes.¹⁹ The existing published studies on the association between prediabetes and skeletal health have shown conflicting results, with some indicating higher BMD values, some lower, and others similar to those of healthy control subjects.^20,21 Particularly, there is limited knowledge regarding the prevalence and temporal trends of osteoporosis and osteopenia in people with prediabetes.

Our findings confirm that almost all the research on ‘osteoporosis and prediabetes’ originated from the HIC, with the USAbeing the nodal country in this research, collaboration and funding. Similarly, all the high-impact articles were published in journals from HIC. Diabetes and prediabetes are highly prevalent in LMIC, where the majority of the global population lives and ironically, there is hardly any research output from these countries. Hence, the true prevalence of ‘prediabetes and osteoporosis’ in these populations is not known. Moreover, the clinical presentations and management strategies of these people in LMIC cannot be ascertained until substantial research comes out of it. We suggest more research funding and international collaboration are needed from the HIC to enable quality research on ‘prediabetes and osteoporosis’ to come out from the LMIC. Biomedical research is essential for improving healthcare delivery. However, there exist significant disparities in the burden of disease, funding for research, and scientific publications between high-income countries (HIC) and low- and middle-income countries (LMIC), which are home to the largest population in the world. While there are numerous challenges, there are also ample opportunities for biomedical research in developing nations. Many developing countries have made efforts to enhance their research capabilities by comprehending their unique problems, needs, and objectives to address their healthcare challenges. Unfortunately, these underprivileged countries continue to face limited prospects for research, education, and training.²²

In their comprehensive analysis, Zhao and Li¹⁹ examined the field of prediabetes research using the Web of Science (WOS) database from 1985 to 2022. They retrieved a total of 9714 research articles published on this topic during the specified period. Li et al.²³ focused on “osteoporosis-related research in adolescents” and analyzed 1199 publications from WOS. Over 29 years, they observed a consistent upward trend, with the United States being the primary contributor (24.3 %) and actively engaging in international research collaborations. Temel et al.²⁴ conducted a bibliometric analysis of the top 100 healthcare professionals (HCPs) involved in the treatment of osteoporosis. Their study revealed significant advancements and emerging trends in this field, providing valuable methodologies and hypotheses for future investigations. Suzan et al.²⁵ evaluated and compared the most widely discussed articles on osteoporosis in both academic and social media platforms. Additionally, Yang et al.²⁶ assessed the bibliometric characteristics and status of cross-sectional studies on osteoporosis and sarcopenia. Notably, there has been a substantial increase in research output on global osteoporosis and sarcopenia from 2000 to 2022.^11,26

Bibliometric analysis serves as a powerful instrument to explore intricate research patterns within a specific field over a period. Utilizing statistical analysis, one can impartially showcase the research contributions made by various countries, institutions, journals, and authors in specific scientific domains. These methodologies efficiently arrange available data, demonstrating the changing patterns, and the results of research are crucial in assessing institutional performance. Additionally, bibliometric analysis provides numerical results and highlights influential researchers, while also documenting the active participation of nations. This strategy effectively pinpoints present research deficiencies and provides valuable perspectives on future research paths by visualizing the framework and dynamics derived from existing data.^{27, 28, 29, 30}

Bibliometric analysis is an effective tool for investigating detailed research trends in a particular field over time. Through statistical analysis, we can objectively present research contributions to specific scientific fields by different countries, institutions, journals, and authors, and predict future directions and hotspots. These techniques organize existing data and represent changing trends, and research outputs are important parameters for measuring institutional performance. Bibliometric analysis provides quantitative results and identifies key researchers. In addition, allows documentation of actively contributing countries. This method identifies current research gaps and provides future research directions by mapping structure and dynamics from existing data.^{27, 28, 29, 30}

While the exact connection remains under investigation, several mechanisms might link prediabetes to weakened bones. Advanced Glycation End Products (AGEs), accumulating in bones, could disrupt bone formation and breakdown, potentially triggering inflammation as well. Insulin resistance (IR), another hallmark of prediabetes, might further disrupt bone cell activity, leading to an imbalance between bone creation and resorption. Additionally, chronic low-grade inflammation, often associated with prediabetes, could wreak havoc on bone metabolism, promoting bone loss. Finally, prediabetes may be linked to lower vitamin D levels, a crucial nutrient for bone health. This complex interplay suggests that managing prediabetes could positively impact bone health and potentially reduce the risk of osteoporosis.³¹

Future directions: The direct link between prediabetes and osteoporosis has not been extensively studied, so far. More research is required to address the prediabetes-osteoporosis association to provide a comprehensive understanding of this relationship. We suggest that such research is done globally and especially from the LMIC, through greater research collaboration, and funding from the national and international bodies.

Limitations: We acknowledge that this study is based on the Scopus data alone, and hence might have missed some of the topic-related papers that were published in journals that are not included in the Scopus. However, Scopus being the biggest database which has the largest number of listed global journals, we believe most of the papers related to the current research topic must have been included. Being a bibliometric study it provides descriptive analyses of existing literature and trends, and not the experimental evidence. While such studies are valuable for understanding research patterns, impact, and collaborations, they suffer from limitations in establishing causation or proving the efficacy of interventions.

5. Conclusion

A total of 272 publications were found in the Scopus database on prediabetes and osteoporosis from 1994 to 2023. The number of publications on this topic has been increasing over three decades. The highest citations per paper were received by publications with had external funding, followed by those which had international collaboration. The high-income countries had the highest research productivity, and impact and contributed all the highly cited papers.

Conflict of interest

Raju Vaishya, Brij Mohan Gupta, Ghouse MN Mamdapur, Anoop Misra, and Abhishek Vaish declare that they have no conflict of interest.

Competing financial interest

All authors declare no competing financial interests.

Funding

No funding in any form was received for this research.

Data availability

The raw data is available with the corresponding author and can be produced, whenever required.

Ethical approval

Not applicable for such bibliometric studies.

Authors’ contribution

-RV: Conceptualization, Literature search, Manuscript writing, editing, and final approval.

-BMG: Data curation, and analysis, Literature search, Manuscript writing, editing, and final approval.

-MGNM: Data curation, and analysis, Literature search, Manuscript writing, editing, and final approval.

-AM: Conceptualization, Literature search, Manuscript writing, editing, and final approval.

-AV: Conceptualization, Literature search, Manuscript writing, editing, and final approval.

Use of AI tool

ChatGPT 3.5 version was used to improve the English and Readability of the article for this study. After using this tool, the author(s) reviewed and edited the content as needed and take full responsibility for the content of the publication.

Appendix A. Supplementary data

The following is/are the supplementary data to this article: