Abstract:Objective To investigate the correlation between bone metabolism and bone mineral density（BMD）related indicators and traditional Chinese medicine（TCM）syndrome patterns in patients with osteopenia. Methods A total of 107 patients with osteopenia admitted to the Department of TCM at Nanjing Drum Tower Hospital from January 2021 to December 2024 were enrolled as study subjects. Data on their bone metabolism and BMD- related indicators were collected. Patients were classified into a kidney deficiency syndrome group（n=45）and a non- kidney deficiency syndrome group（n=62）based on TCM pattern differentiation. The severity of abnormalities in bone metabolism and BMD，along with potential influencing factors，were compared between the two groups Multivariate logistic regression was used to analyze the influencing factors of kidney deficiency syndrome with osteopenia. Pearson or Spearman correlation analyses were used to assess the associations between age，body mass index（BMI），and bone metabolism or BMD indicators. Results Logistic regression analysis revealed that low serum 25?hydroxyvitamin D levels，low T?score for lumbar spine L2 BMD，and low T?score for lumbar spine L3 BMD were risk factors for developing kidney deficiency syndrome in patients with osteopenia（P<0.05）. Pearson correlation analysis showed a negative linear correlation between age and femoral neck T- score（r=-0.206，P=0.033）. Spearman correlation analysis indicated there were the positive linear correlations between BMI and lower limbs total BMD T?score，between serum β?crosslinked C?telopeptide of type I collagen（β?CTX）and procollagen type I N-terminal propeptide（PINP）, between serum 25?hydroxyvitamin D and lumbar spine L1 BMD T- score（r=0.308，P=0.001；r=0.703，P<0.001；r=0.209，P=0.030），while a negative linear correlation between between β?CTX and serum 25? hydroxyvitamin D（r=-0.212，P=0.029）. Conclusion There is a certain correlation between serum 25?hydroxyvitamin D levels，lumbar spine L2 T?score，lumbar spine L3 T?score，and the occurrence of Kidney deficiency syndrome in patients with osteopenia. Correlations also exist between age，bone metabolism indicators，and BMD.