Fig. 1

The flowchart for the participant selection strategy. From January 2014 to January 2021, the data were sourced from the Medical Record Database of the People’s Hospital of Guangxi Zhuang Autonomous Region. Finally, 363 postmenopausal females with T2DM were recruited in this present analysis. According to the SAR, all participants were split into three groups: low-level (≤ 98.24, n = 121), moderate-level (98.24–157.25, n = 121), and high-level (≥ 157.25, n = 121). The relationships between the SAR and a real-world fragility fracture event and a future individual 10-year probability of MOF and HF calculated by the FRAX were evaluated through Spearman’s partial correlation analysis, RCS model, Cox proportional hazards regression model, and Kaplan-Meier survival analysis. Furthermore, the diagnostic efficacy comparisons of the SAR with the GNRI, PNI, and SII were conducted through the ROC curve analysis and DCA