The association of the TyG index-related parameters and bone health status in men aged 50 and over: a cross-sectional analysis of Bushehr Elderly Health (BEH) Program

The association of the TyG index-related parameters and bone health status in men aged 50 and over: a cross-sectional analysis of Bushehr Elderly Health (BEH) Program | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The association of the TyG index-related parameters and bone health status in men aged 50 and over: a cross-sectional analysis of Bushehr Elderly Health (BEH) Program Shahrzad Mohseni, Kazem Khalagi, Alireza Amanollahi, Noushin Fahimfar, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8964930/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The triglyceride-glucose (TyG) index and its related parameters (TyG-BMI, TyG-WC, and TyG-WHtR) have emerged as sensitive and cost-effective markers of insulin resistance (IR). However, limited research has investigated the association between these parameters with bone health. This study aimed to evaluate the association between TyG and its related parameters with bone mineral density (BMD), as surrogate markers of IR and bone health among men over 50 years utilizing data from the Bushehr Elderly Health (BEH) program. Methods This cross-sectional analysis utilized data from the BEH Program involving 851 older adult men aged 50 years or more. Bone health was assessed using BMD measurements at the lumbar spine, total hip, and femoral neck, and trabecular bone score (TBS). Low BMD (osteopenia/osteoporosis) and osteoporosis were defined as a T-score lower than 1 standard deviation (SD) below the reference mean (− 1 or lower) and 2.5 SD or more below reference mean (− 2.5 and lower) in at least one site, respectively. Results The mean age of the study participants was 62.9 ± 0.2 years, of whom 151 (17.74%) had osteoporosis. Through multivariate linear and logistic regression analysis, TyG and its related parameters (except TyG-WHtR) exhibited a significant positive association with BMD and a negative association with osteoporosis/ low BMD at each bone site. Conversely, TyG-BMI and TyG-WHtR showed negative associations with TBS (p < 0.001) after adjustment for confounding factors. Conclusions These findings highlighted that TyG index-related parameters may serve as valuable markers in evaluating bone health in older adult men. TyG Bone mineral density Trabecular bone score Bone health Osteoporosis Iran Introduction Osteoporosis, is a metabolic bone disorder characterized by low bone mineral density and deterioration in the microarchitecture of bone tissue, resulted in bone fragility and susceptibility to fracture [ 1 ]. The global prevalence of osteoporosis is 18.3% (11.7% in men and 23.1% in women) and is more common in developing countries [ 2 ]. According to the Osteoporosis Diagnostic Guidelines, the prevalence of osteoporosis rises nearly exponentially in individuals over the age of 50 [ 3 , 4 ]. A pooled meta-analysis among the general population ≥ 50 years old in Iran found the prevalence of osteoporosis to be 25% in men and to be as high as 38% in women [ 5 ], which is higher than the global prevalence. Insulin impacts bone remodeling by regulating both the formation of bone through osteoblasts and the resorption of bone by osteoclasts[ 6 ]. Insulin resistance (IR) refers to the condition in which peripheral tissues are unable to respond to insulin[ 7 ]. Whether IR can affect bone metabolism remains unclear. Findings from recent research investigating the association between IR and osteoporosis, are inconsistent. While the gold standard method for assessing insulin resistance is the hyperinsulinemic-euglycemic clamp technique, and Homeostatic Model of Insulin Resistance (HOMA-IR), these techniques are complex, time-consuming, and are not feasible for routine clinical practice[ 8 ]. As an alternative approach for assessing IR, the triglyceride-glucose (TyG) index- which combines using available clinical laboratory values (fasting triglyceride levels and fasting plasma glucose)- has been proposed as a cost-effective, non-invasive and highly sensitive marker [ 9 , 10 ]. It has been shown that, TyG may have better performance in evaluating IR than HOMA-IR [ 11 ]. Furthermore, it is worth noting that individuals with IR, often suffer from obesity[ 12 ], a condition that can affect bone health[ 13 ]. Existing evidence reveals that IR and obesity are associated with bone mineral density (BMD) and osteoporosis [ 14 , 15 ]. Additionally, in recent years several researchers have stated that the combination of the TyG index with obesity related indices (e.g., TyG-body mass index [BMI], TyG-waist circumference [WC] and TyG-waist to height ratio [WHtR]) may superior to TyG alone to identify IR[ 16 – 18 ]. However, the evidence regarding the advantage of TyG and its related indices in evaluating BMD is scarce and inconsistence. Due to the higher incidence rate of osteoporosis in women aged 50 years and over, the larger body of evidence are focused on older adult women, with less emphasis on men. However, some evidence indicates that osteoporosis complications are more common in men than women[ 19 , 20 ]. Hence, we conducted this study to evaluate the association between TyG and its related parameters with bone health, as surrogate markers of IR and bone health among men over 50 years living in Bushehr, Iran, utilizing data from the second recruitment of the Bushehr Elderly Health (BEH) program. To our knowledge, this is the first study to assess the relationships between TyG-related parameters and both BMD and trabecular bone score (TBS). Moreover, our novel approach evaluates TyG combined with central obesity indices simultaneously, providing insights into the interplay of insulin resistance, adiposity, and bone health in men. Methods Study population The present study was a cross-sectional analysis of 851 male participants over 50 years of age using findings from the second recruitment of the BEH program (PoCOsteo study). BEH program is a prospective cohort study conducted by the Endocrinology and Metabolism Research Institute (EMRI) at Tehran University of Medical Sciences (TUMS), and Persian Gulf Marine Biotechnology Research Centre (PGTMRC) at Bushehr University of Medical Sciences. BEH program aimed to investigate the prevalence and incidence of non-communicable diseases (NCDs) and their risk factors among the elderly population [ 21 ]. The second recruitment of the BEH program (PoCOsteo study) was implemented in 2018–2019 and adds 2000 new sample aged ≥ 50 years to the BPH program. The study population consisted of residents of Bushehr city aged 50 and over, who were selected using a multi-stage stratified cluster sampling method. Trained interviewers collected information on age, education level, medical history, tobacco smoking (cigarettes or water pipes) and medication use through a comprehensive, valid questionnaire. The height and weight of individuals were measured by a fixed stadiometer and a digital scale after wearing light clothes and taking the shoes off. Waist circumferences was measured using a flexible and fixed elastic band at the midpoint between the last rib and the iliac crest. After overnight fasting for 8–12-hour, 20 ml of venous blood sampling were obtained. Commercial kits (Pars Azmoon, Karaj, Iran) were used to total cholesterol, high density lipoprotein- cholesterol (HDL-C), low density lipoprotein- cholesterol (LDL-C), triglycerides, blood urea nitrogen (BUN), alkaline phosphatase (ALP), and serum 25-hydroxy vitamin D3 concentration. All participants signed a written informed. The detailed protocol and methodology of the PoCOsteo study has described elsewhere [ 22 ]. Participants who had incomplete data and invalid data were excluded from the analysis. The protocol of the current study was reviewed and accepted by Ethics Committee of the Endocrinology and Metabolism Research Institute (ID code: IR.TUMS.EMRI.REC.1403.072). This study was conducted in accordance with the Declaration of Helsinki. Assessment of bone mineral density and trabecular bone score For all participants, bone quantity and quality were assessed through bone mineral density (BMD) measurements and trabecular bone score (TBS), respectively. BMD was evaluated at the lumbar spine, total hip, and femoral neck using a dual-energy X-ray absorptiometry (DXA) system (Hologic, Bedford, MA, USA). Participants were categorized according to their T-score values based on WHO definitions [ 23 ]. The reference population for T-score calculation is bone mass at each site in young Caucasian women. Those with a T-score of 2.5 SD or more below reference mean (− 2.5 and lower) in at least one site were classified as osteoporotic, and others as non-osteoporotic. Additionally, we considered individuals with a T-score lower than 1 SD below the reference mean (− 1 or lower) at each site as having low BMD, encompassing both osteopenia and osteoporosis. Definition of terms BMI was calculated by dividing weight in kilograms by the square of height in meters. Participants who were smoking cigarettes daily or occasionally and those who used hookah or pipes were classified as current smokers. Waist-to-height ratio (WHtR) was defined as WC (cm) divided by body height (m) [ 24 ]. The TyG related indices were calculated as follows: TyG index = Ln [TG (mg/dL) × FPG (mg/dL)]/2 [ 25 ] TyG-BMI = TyG × BMI (kg/m 2 ) [ 16 ] TyG-WHtR = TyG × WHtR [ 26 ] TyG-WC = TyG × WC (cm)[ 27 ] Statistical analyses Quantitative variables were described as means with standard deviations, and categorical variables were presented as counts and percentages. To compare continuous variables and categorical variables between study groups, independent t-tests and chi-square tests were applied, with the assumptions of normality and homogeneity of variances verified. Associations between study outcomes (osteoporosis, low BMD, TBS L1–L4, BMDs of lumbar spine (L1–L4), total hip, and femoral neck) and independent variables (TyG, TyG-BMI, TyG-WC, and TyG-WHtR) were assessed using linear and logistic regression models, depending on the outcome type. Additional models were estimated adjusting for potential confounders based on the literature review. Collinearity among predictors and residual behavior was also assessed. Variance Inflation Factor (VIF) was used to test collinearity between variables and residual model also had a mean of zero and a standard deviation of 1. All statistical analyses were conducted at a significance level of 0.05 using Stata software. Results Clinical characteristics of the study population Table 1 presents the demographic characteristic, clinical and biochemical data of study population according to the osteoporosis status. A total of 851 male participants of > 50 years were included in the analysis. The mean age of the subjects was 62.9 ± 0.2 years of whom 151 (17.7%) had osteoporosis. Compared to non-osteoporotic group, those with osteoporosis were likely to be older and being more smoker, exhibited a lower educational level, had lower BMI and waist circumference, and presented decreased levels of TG, TyG index, TyG-BMI, TyG-WC, and TyG-WHtR. (p < 0.05). Association of TyG-index related parameters with BMD The association between TyG-index related parameters and BMD status are displayed in Table 2 . In simple regression model, it was revealed a positive association between these four indices and BMD at lumbar spine (L1-L4), total hip, and femoral neck (P < 0.001). However, after adjusting for confounding factors, all of the associations remained statistically significant, except for TyG-WHtR, which exhibited no association with BMD at each site. After adjusting for all confounding factors, one-unit increases in TyG, TyG-BMI, and TyG-WC was associated with 0.0661 g/cm 2 , 0.0012 g/cm 2 , and 0.0002 g/ cm 2 increase in lumbar spine BMD, respectively. One-unit increases in TyG, TyG-BMI, and TyG-WC was associated with 0.0499 g/cm 2 , 0.001 g/cm 2, and 0.0001 g/cm 2 increase in total hip BMD. Finally, one-unit increases in TyG, TyG-BMI, and TyG-WC was associated with 0.0373 g/cm 2 , 0.0008 g/cm 2 , and 0.0001 g/cm 2 increase in femoral neck BMD. Table 2 The association between TyG-index related parameters and bone mineral density among study participants crude adjusted * ß (%95 CI) p-value ß (%95 CI) p-value Lumbar spine (L1-L4) TyG 0.042(0.024, 0.059) < 0.001 0.0661(0.0355, 0.0967) < 0.001 TyG-BMI 0.0012(0.001, 0.0015) < 0.001 0.0012(0.001, 0.0014) < 0.001 TyG-WC 0.0004(0.0003, 0.0005) < 0.001 0.0002(0.0001, 0.0003) 0.004 TyG-WHtR 0.060(0.046, 0.074) < 0.001 0.0082(-0.0146, 0.0311) 0.480 Total hip TyG 0.038(0.023, 0.054) < 0.001 0.0499(0.0248, 0.0750) < 0.001 TyG-BMI 0.0012(0.001, 0.0014) < 0.001 0.001(0.0008, 0.0012) < 0.001 TyG-WC 0.0003(0.0002, 0.0004) < 0.001 0.0001(0.00004, 0.0002) 0.007 TyG-WHtR 0.048(0.036, 0.060) < 0.001 0.0029(-0.0157, 0.0217) 0.756 Femoral neck TyG 0.033(0.018, 0.047) < 0.001 0.0373(0.0139, 0.0607) 0.002 TyG-BMI 0.001(0.0008, 0.0012) < 0.001 0.0008(0.0006, 0.001) < 0.001 TyG-WC 0.0003(0.0002, 0.0004) < 0.001 0.0001(0.00002, 0.0002) 0.015 TyG-WHtR 0.038(0.026, 0.049) < 0.001 -0.0039(-0.0214, 0.0134) 0.654 *Adjusted for Age, BUN, ALP, HDL-C, LDL-C, Cholesterol, vitamin D, education, smoking, BMI (except for TyG-BMI). Abbreviations: CI, Confidence interval; TyG, Triglyceride-glucose; BMI, body mass index; WC, Waist circumference; WHtR, Waist-to-height ratio. Association of TyG-index related parameters with TBS The association between TyG, TyG-BMI, TyG-WC, and TyG-WHtR w TBS are displayed in Table 3 . In the crude model, all indices except TyG showed significant negative associations. After adjusting for confounding factors, all of the indices exhibited significant associations with TBS, except for TyG-WC which showed no associations. After adjusting for confounding factors, one-unit increases in TyG was associated with 0.0129 g/cm 2 increases in TBS, while one-unit increases in TyG -BMI and TyG-WHtR was associated with 0.0005 g/cm 2 and 0.0454 g/cm 2 decreases in TBS, respectively. Table 3 Association between TyG-index related parameters and TBS among study participants crude adjusted * ß (%95 CI) p-value ß (%95 CI) p-value TBS ( L1-L4 ) TyG 0.005(-0.005, 0.015) 0.345 0.0129(0.0027, 0.0231) 0.013 TyG-BMI -0.0004(-0.0006, -0.0003) < 0.001 -0.0005(-0.0006, -0.0004) < 0.001 TyG-WC -0.00017(-0.00022, -0.00012) < 0.001 -0.00004(-0.0001, 0.00003) 0.240 TyG-WHtR -0.034(-0.042, -0.025) < 0.001 -0.0454(-0.0549, -0.0359) < 0.001 *Adjusted for Age, BUN, ALP, HDL-C, LDL-C, Cholesterol, vitamin D, education, smoking, BMI (except for TyG-BMI). Abbreviations: CI, Confidence interval; TBS, Trabecular bone score; TyG, Triglyceride-glucose; BMI, body mass index; WC,Waist circumference; WHtR, Waist-to-height ratio Association between TyG-index related parameters and osteoporosis/low BMD Table 4 displays the associations of osteoporosis and low BMD with TyG indices. Logistic regression analysis revealed statistically significant association across both crude and adjusted models with osteoporosis and low BMD except for adjusted TyG-WHtR. It was revealed that higher TyG index, TyG-BMI and TyG-WC may be related with lower odds of osteoporosis or low BMD even after adjusting for confounding factors. Table 4 Logistic regression analysis assessed the association between TyG-index related parameters with osteoporosis and low BMD crude adjusted * OR (%95 CI) p-value OR (%95 CI) p-value Osteoporosis TyG 0.537(0.391, 0.737) < 0.001 0.676(0.482, 0.949) 0.024 TyG-BMI 0.982(0.977, 0.986) < 0.001 0.982(0.977, 0.987) < 0.001 TyG-WC 0.994(0.992, 0.996) < 0.001 0.996(0.994, 0.999) 0.018 TyG-WHtR 0.512(0.398, 0.658) < 0.001 1.004(0.651, 1.546) 0.985 Low BMD TyG 0.693(0.551, 0.874) 0.002 0.433(0.269, 0.696) 0.001 TyG-BMI 0.987(0.984, 0.991) < 0.001 0.987(0.983, 0.991) < 0.001 TyG-WC 0.996(0.995, 0.997) < 0.001 0.995(0.994, 0.997) < 0.001 TyG-WHtR 0.638(0.525, 0.776) < 0.001 1.079(0.765, 1.521) 0.663 *Adjusted for Age, BUN, ALP, HDL-C, LDL-C, Cholesterol, vitamin D, education, smoking, BMI (except for TyG-BMI). Abbreviations: OR, Odds ratio; CI, Confidence interval; TyG, Triglyceride-glucose; BMI, Body mass index; WC, Waist circumference; WHtR, Waist-to-height ratio; BMD, Bone mineral density Discussion This cross-sectional study investigated the associations between TyG-index and its related parameters (TyG-BMI, TyG-WC, TyG-WHtR) with BMD, osteoporosis, and TBS in men over 50 years from the Bushehr Elderly Health (BEH) program. The findings demonstrated a significant relationship where higher TyG, TyG-BMI, and TyG-WC levels were positively associated with BMD at lumbar spine, total hip, and femoral neck, and inversely associated with osteoporosis and low BMD. This suggests that these indices may serve as useful surrogate markers for bone health assessment in older men. Moreover, we found that TyG had significant positive association with TBS, while TyG-BMI and TyG-WHtR exhibited significant negative associations with TBS. Beyond genetic factors, age, and lifestyle conditions[ 28 ], recent research has highlighted the significant association of impaired glucose and lipid metabolism with bone metabolism [ 29 , 30 ]. However, previous studies have highlighted the limited predictive ability of TG or HDL-C and have shown inconsistent associations between these two parameters and the risk of osteoporosis[ 31 ]. Consequently, composite indices incorporating glucose and lipid parameters including TyG, TyG-BMI, TyG-WC, and TyG-WHtR have been created that all are reliable surrogate markers of IR[ 32 ]. Recently, a growing number of studies have been published focusing on novel glucolipid metabolism-related markers aimed at improving predictive accuracy[ 33 , 34 ]. The underlying mechanism between bone and glucose metabolism is complex and not completely understood. Insulin signaling regulates osteoblast proliferation while inhibiting osteoclasts activity, resulting in bone formation. In the state of IR, the insulin sensitivity reduces, causing the pancreas to increase insulin secretion and leading to hyperinsulinemia. This elevated insulin level further enhances bone mass[ 6 ]. Additionally, hyperinsulinemia can negatively affect sex hormone–binding globulin, that resulted in higher levels of free sex hormones, which might help protect against bone loss[ 35 ]. On the other hand, elevated levels of proinflammatory cytokines including IL-6, IL-1 and TNF-α are frequently observed in individuals with insulin resistance. These mediators promote osteoclasts differentiation and activity via stimulate the RANK/RANKL/OPG signaling cascade, and accelerating bone loss [ 36 ]. This may account for the observed inconsistent or insignificant associations between TyG index and BMD reported by various studies. Research has revealed a strong link between a higher TyG index and changes in BMD among diverse groups, emphasizing the complex relationship between metabolic health and bone strength [ 37 , 38 ]. While some cross-sectional studies indicated that a higher TyG index, is associated with reduced BMD and a greater risk of osteoporosis[ 37 ], some others found no significant correlation or proposed a possible protective effect in certain populations [38, 39] . Consistent with our findings, Zeng et al.[ 40 ] in a cohort of 1,622 middle-aged and older Chinese men, followed from 2015 to 2022, found that higher values of TyG, were associated with a reduced risk [hazard ratios, 95%CI: 0.573 (0.336–0.976)] of developing osteoporosis. Yoon et al.[ 37 ], found a negative relationship between the TyG index and femoral neck BMD in Korean non-diabetic men population aged ≥ 50 years. Likewise, Zhan et al.[ 31 ] analyzed data of 3646 subjects (53.6% male) aged ≥ 20 years from National Health and Nutrition Examination Survey (NHANS). Their findings revealed a negative correlation between TyG index and lumbar spine BMD among 1956 men (β = −0.017, 95% CI: − 0.028, − 0.005). Tian et al.[ 38 ] identified a significant positive association between TyG index and total BMD (excluding post-menopausal women), with regression coefficients rising when the TyG index exceeded 9.106. However, after adjusting for confounding factors, this association lost among men. Chen et al.[ 41 ] using data from NHANES (2005–2018), found no association between TyG index and femoral neck BMD in non-diabetic men and post-menopausal women aged ≥ 50 years, as well as the odds for low BMD. These discrepancies may be contributed to variations in the age of study populations, demographics and adjusting factors. We also found a positive association between the TyG-BMI index and BMD across all sites, and further identified its protective role against osteoporosis and low BMD. Consistent with our findings, Xuan et al.[ 42 ] examined TyG-BMI’s relationship with femoral neck BMD encompassing 1182 non-diabetic men of 50 years and more using NHANES data. Their analysis demonstrated a positive, and nonlinear relationship between TyG-BMI and femoral neck BMD, indicating that increased insulin resistance combined with BMI may improve bone density. Lai et al. [ 43 ] in a recent cross-sectional study in 1,303 adults aged 50 ≥ years from the NHANES (2007–2014) revealed that TyG-BMI had significant positive association with BMD at femoral neck, total hip and lumbar spine region and a negative association with osteopenia/osteoporosis risks in both genders. These findings are supported by another research [ 44 ]. Likewise, Zeng et al.[ 40 ] reported that TyG-BMI was associated with reduced incidence of male osteoporosis. The protective effect noted may partly reflect the mechanical loading exerted by higher body mass, which stimulates osteoblastic activity, and promoting bone formation [ 45 ]. Another mechanism to explain is the elevation of serum insulin-like growth factor-1 (IGF-1) in overweight/obese individuals that promoting bone growth and mineralization[ 46 ]. These explanations support the hypothesis that moderate obesity could enhance bone density, consistent with existing literature indicating that a BMI of up to 35 kg/m² beneficially affecting BMD in men[ 47 ]. Evidence regarding the association of TyG-WC and BMD status are limited. The TyG-WC index, which incorporates waist circumference, is a reliable tool for assessing the risk of IR linked to abdominal obesity. High waist circumference, indicator of body fat distribution, specifically visceral fat contributes to the release of pro-inflammatory cytokines and altered lipid metabolism, both of which worsen insulin sensitivity and increase IR risk[ 48 , 49 ]. In the present study, after adjusting for confounders, we found that TyG-WC was positively associated with BMD at each site. Moreover, TyG-WC was associated with lower risk of osteoporosis and low BMD. Consistent with our findings, Lai et al. [ 43 ] similarly reported positive associations of TyG-WC with BMD and a protective effect on bone loss in older males and females. These findings suggest TyG-WC could provide incremental predictive value beyond TyG alone for bone health assessment in clinical practice. In the present study no correlation was found between TyG-WHtR and BMD as well as osteoporosis/low BMD after adjusting for confounding factors. Research on the association between the TyG- WHtR index and BMD is restricted with inconsistent results. Lai et al. [ 43 ] demonstrated that TyG-WHtR have a significant positive relationship with BMD and a negative relationship with osteopenia/osteoporosis in the lumbar spine, total hip and femoral neck region among men and women aged ≥ 50 years. Tian et al.[ 38 ] evaluated NHANES data (2011–2018) with 5456 participants (mean age: 30.33 ± 13.55 years, 55.65% males) and reported a significant protective effect of TyG- WHtR against bone loss. The regression coefficient rised when TyG- WHtR exceeded the threshold of 4.065 and when TyG-WHtR exceeded its threshold, the regression coefficient decreases. However, like our findings after subgroup analysis, the significancy lost among male gender. WHtR measures waist circumference relative to height and serves as an effective indicator of central adiposity. In terms of bone health, prior studies suggest that central obesity can contribute to bone loss by triggering chronic inflammation, disrupting metabolism of the adipose tissue, and causing IR, which collectively increase the risk of osteoporosis[ 50 ]. To our knowledge this is the first study that assessment the relationships between TyG-related parameters and TBS (L1-L4) status. It was revealed that TyG-BMI and TyG- WHtR exhibited a negative association with TBS after adjustment, indicating potential adverse effects on bone microarchitecture despite favorable correlations with BMD. The exact mechanism of the associations of these indices with TBS are not explained, but it might be contributed to changes in glucose regulation and sex hormone levels[ 51 ]. Moreover, as these parameters are surrogate markers of insulin resistance, it has been shown that insulin resistance is associated with worse trabecular bone quality[ 52 ]. Future longitudinal studies are required to clarify these relationships and potential causal pathways. Main strengths of the present study include large community-based sample, comprehensive adjustment for confounders, and focus on men aged 50 and over as guidelines indicate that the likelihood of osteoporosis rises abruptly after age 50, which enhances the relevance and clinical significance of our research. Finally, we applied a broadly important confounding factors, that enhance the reliability of the findings. Our results made the foundation for further longitudinal cohort studies. However, the cross-sectional design precludes causal implication and reverse causality cannot be excluded. Conclusions In conclusion, this study highlighted that the TyG index-related parameters especially TyG-BMI and TyG-WC, are positively associated with BMD and may serve as cost-effective, surrogate markers for bone health and osteoporosis risk stratification in older adult men. These findings underscore the complex interaction between insulin resistance, adiposity, and skeletal health. Longitudinal research is warranted to clarify causal relationships and explore underlying biological mechanisms. incorporating these indices into clinical practice may improve early identification and management of osteoporosis in aging male populations. Abbreviations Declarations Ethics approval This study was conducted in accordance with the Declaration of Helsinki. The protocol of the current study was reviewed and accepted by Ethics Committee of the Endocrinology and Metabolism Research Institute (ID code: IR.TUMS.EMRI.REC.1403.072). Funding Not applicable. Availability of data and materials The data used in this study are from the Bushehr Elderly Health (BEH) program, a population-based cohort study owned and governed by the Ministry of Health and Medical Education of the Islamic Republic of Iran through the Persian Cohort and Biobank regulations. Due to ethical and legal restrictions on sharing potentially identifiable human data and national regulations, the raw dataset cannot be made publicly available. However, the de-identified minimal dataset underlying the results of this study is available upon reasonable request to the project administrator. Acknowledgement The present study ( ethic code: IR.TUMS.EMRI.REC.1403.072), was a secondary analysis of data from the Bushehr Elderly Health (BEH) Program (ethic code: IR.TUMS.EMRI.REC.1394.0036). Authors’ contributions SHM: Writing (original draft, and editing); KK: Methodology, validation , AA: Formal analysis; NF: Validation, supervision ; MPS: Conceptualization; supervision; IN and AO: Project administration. All authors reviewed the manuscript and approved the final version. Conflict of Interest The authors declared that they have no conflict of interest. Human Ethics and Consent to Participate declarations Not applicable . Clinical trial number Not applicable References Qaseem A, Forciea MA, McLean RM, Denberg TD, Clinical Guidelines Committee of the American College of P, Barry MJ, et al. Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update From the American College of Physicians. Ann Intern Med. 2017;166(11):818–39. 10.7326/M15-1361 . Salari N, Ghasemi H, Mohammadi L, Behzadi MH, Rabieenia E, Shohaimi S, et al. The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis. J Orthop Surg Res. 2021;16:1–20. Vondracek SF, Linnebur SA. Diagnosis and management of osteoporosis in the older senior. Clin Interv Aging. 2009;4:121–36. 10.2147/cia.s4965 . Clynes MA, Harvey NC, Curtis EM, Fuggle NR, Dennison EM, Cooper C. The epidemiology of osteoporosis. Br Med Bull. 2020;133(1):105–17. 10.1093/bmb/ldaa005 . Fahimfar N, Hesari E, Mansourzadeh MJ, Khalagi K, Sanjari M, Hajivalizadeh S, et al. Prevalence of osteoporosis in the Iranian population: a systematic review and meta-analysis. J Diabetes Metab Disord. 2024;23(1):229–37. 10.1007/s40200-023-01352-9 . Conte C, Epstein S, Napoli N. Insulin resistance and bone: a biological partnership. Acta Diabetol. 2018;55(4):305–14. 10.1007/s00592-018-1101-7 . Haffner SM, Valdez RA, Hazuda HP, Mitchell BD, Morales PA, Stern MP. Prospective analysis of the insulin-resistance syndrome (syndrome X). Diabetes. 1992;41(6):715–22. 10.2337/diab.41.6.715 . Pan J, Huang X, Wang Q, Sun J, Zhai Z, Mo J, et al. Triglyceride Glucose Index is Strongly Associated with a Fragility Fracture in Postmenopausal Elderly Females with Type 2 Diabetes Mellitus Combined with Osteoporosis: A 6-Year Follow-Up Study. Clin Interv Aging. 2023;18:1841–9. 10.2147/CIA.S434194 . Simental-Mendia LE, Rodriguez-Moran M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 2008;6(4):299–304. 10.1089/met.2008.0034 . Mohseni S, Sani MP. Association Between Triglyceride-glucose Related Indices and Bone Health: A Review Study. Iran J Diabetes Metabolism. 2025;25(4):299–307. Son DH, Lee HS, Lee YJ, Lee JH, Han JH. Comparison of triglyceride-glucose index and HOMA-IR for predicting prevalence and incidence of metabolic syndrome. Nutr Metab Cardiovasc Dis. 2022;32(3):596–604. 10.1016/j.numecd.2021.11.017 . Suren Garg S, Kushwaha K, Dubey R, Gupta J. Association between obesity, inflammation and insulin resistance: Insights into signaling pathways and therapeutic interventions. Diabetes Res Clin Pract. 2023;200:110691. 10.1016/j.diabres.2023.110691 . Palermo A, Tuccinardi D, Defeudis G, Watanabe M, D'Onofrio L, Lauria Pantano A, et al. BMI and BMD: The Potential Interplay between Obesity and Bone Fragility. Int J Environ Res Public Health. 2016;13(6). 10.3390/ijerph13060544 . Maimoun L, Mura T, Leprieur E, Avignon A, Mariano-Goulart D, Sultan A. Impact of obesity on bone mass throughout adult life: Influence of gender and severity of obesity. Bone. 2016;90:23–30. 10.1016/j.bone.2015.11.020 . Fu YH, Liu WJ, Lee CL, Wang JS. Associations of insulin resistance and insulin secretion with bone mineral density and osteoporosis in a general population. Front Endocrinol (Lausanne). 2022;13:971960. 10.3389/fendo.2022.971960 . Er LK, Wu S, Chou HH, Hsu LA, Teng MS, Sun YC, et al. Triglyceride Glucose-Body Mass Index Is a Simple and Clinically Useful Surrogate Marker for Insulin Resistance in Nondiabetic Individuals. PLoS ONE. 2016;11(3):e0149731. 10.1371/journal.pone.0149731 . Lim J, Kim J, Koo SH, Kwon GC. Comparison of triglyceride glucose index, and related parameters to predict insulin resistance in Korean adults: An analysis of the 2007–2010 Korean National Health and Nutrition Examination Survey. PLoS ONE. 2019;14(3):e0212963. 10.1371/journal.pone.0212963 . Kim HS, Cho YK, Kim EH, Lee MJ, Jung CH, Park JY, et al. Triglyceride Glucose-Waist Circumference Is Superior to the Homeostasis Model Assessment of Insulin Resistance in Identifying Nonalcoholic Fatty Liver Disease in Healthy Subjects. J Clin Med. 2021;11(1). 10.3390/jcm11010041 . Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. 1999;353(9156):878–82. 10.1016/S0140-6736(98)09075-8 . Grewal S, Jawad AS. Morbidity associated with osteoporosis significant in older men. Trends Urol Men's Health. 2022;13(4):22–6. 10.1002/tre.868 . Shafiee G, Ostovar A, Heshmat R, Darabi H, Sharifi F, Raeisi A, et al. Bushehr Elderly Health (BEH) programme: study protocol and design of musculoskeletal system and cognitive function (stage II). BMJ Open. 2017;7(8):e013606. 10.1136/bmjopen-2016-013606 . Khashayar P, Dimai HP, Moradi N, Fahimfar N, Gharibzadeh S, Ostovar A, et al. Protocol for a multicentre, prospective cohort study of clinical, proteomic and genomic patterns associated with osteoporosis to develop a multidimensional fracture assessment tool: the PoCOsteo Study. BMJ Open. 2020;10(9):e035363. 10.1136/bmjopen-2019-035363 . Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994;4(6):368–81. 10.1007/BF01622200 . Nevill AM, Stewart AD, Olds T, Duncan MJ. A new waist-to-height ratio predicts abdominal adiposity in adults. Res Sports Med. 2020;28(1):15–26. 10.1080/15438627.2018.1502183 . Guerrero-Romero F, Simental-Mendia LE, Gonzalez-Ortiz M, Martinez-Abundis E, Ramos-Zavala MG, Hernandez-Gonzalez SO, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010;95(7):3347–51. 10.1210/jc.2010-0288 . Malek M, Khamseh ME, Chehrehgosha H, Nobarani S, Alaei-Shahmiri F. Triglyceride glucose-waist to height ratio: a novel and effective marker for identifying hepatic steatosis in individuals with type 2 diabetes mellitus. Endocrine. 2021;74(3):538–45. 10.1007/s12020-021-02815-w . Khamseh ME, Malek M, Abbasi R, Taheri H, Lahouti M, Alaei-Shahmiri F. Triglyceride Glucose Index and Related Parameters (Triglyceride Glucose-Body Mass Index and Triglyceride Glucose-Waist Circumference) Identify Nonalcoholic Fatty Liver and Liver Fibrosis in Individuals with Overweight/Obesity. Metab Syndr Relat Disord. 2021;19(3):167–73. 10.1089/met.2020.0109 . Afarideh M, Sartori-Valinotti JC, Tollefson MM. Association of Sun-Protective Behaviors With Bone Mineral Density and Osteoporotic Bone Fractures in US Adults. JAMA Dermatol. 2021;157(12):1437–46. 10.1001/jamadermatol.2021.4143 . Zhou H, Li C, Song W, Wei M, Cui Y, Huang Q, et al. Increasing fasting glucose and fasting insulin associated with elevated bone mineral density-evidence from cross-sectional and MR studies. Osteoporos Int. 2021;32(6):1153–64. 10.1007/s00198-020-05762-w . Jiang J, Qiu P, Wang Y, Zhao C, Fan S, Lin X. Association between serum high-density lipoprotein cholesterol and bone health in the general population: a large and multicenter study. Arch Osteoporos. 2019;14(1):36. 10.1007/s11657-019-0579-0 . Zhan H, Liu X, Piao S, Rong X, Guo J. Association between triglyceride-glucose index and bone mineral density in US adults: a cross sectional study. J Orthop Surg Res. 2023;18(1):810. 10.1186/s13018-023-04275-6 . Hou XZ, Lv YF, Li YS, Wu Q, Lv QY, Yang YT, et al. Association between different insulin resistance surrogates and all-cause mortality in patients with coronary heart disease and hypertension: NHANES longitudinal cohort study. Cardiovasc Diabetol. 2024;23(1):86. 10.1186/s12933-024-02173-7 . Cui C, Qi Y, Song J, Shang X, Han T, Han N, et al. Comparison of triglyceride glucose index and modified triglyceride glucose indices in prediction of cardiovascular diseases in middle aged and older Chinese adults. Cardiovasc Diabetol. 2024;23(1):185. 10.1186/s12933-024-02278-z . Li J, Ma C, Wang X, Li J, Liu P, Zhu M. Development and validation of a novel glucolipid metabolism-related nomogram to enhance the predictive performance for osteoporosis complications in prediabetic and diabetic patients. Lipids Health Dis. 2025;24(1):183. 10.1186/s12944-025-02602-w . Birkeland KI, Hanssen KF, Torjesen PA, Vaaler S. Level of sex hormone-binding globulin is positively correlated with insulin sensitivity in men with type 2 diabetes. J Clin Endocrinol Metab. 1993;76(2):275–8. 10.1210/jcem.76.2.8432768 . Ponzetti M, Rucci N. Updates on Osteoimmunology: What's New on the Cross-Talk Between Bone and Immune System. Front Endocrinol (Lausanne). 2019;10:236. 10.3389/fendo.2019.00236 . Yoon JH, Hong AR, Choi W, Park JY, Kim HK, Kang HC. Association of Triglyceride-Glucose Index with Bone Mineral Density in Non-diabetic Koreans: KNHANES 2008–2011. Calcif Tissue Int. 2021;108(2):176–87. 10.1007/s00223-020-00761-9 . Tian N, Chen S, Han H, Jin J, Li Z. Association between triglyceride glucose index and total bone mineral density: a cross-sectional study from NHANES 2011–2018. Sci Rep. 2024;14(1):4208. 10.1038/s41598-024-54192-9 . Hung YT, Yu TH, Alizargar J. Insulin Resistance and Bone Mineral Density: A Comprehensive Examination Using UK Biobank Data. Healthc (Basel). 2024;12(24). 10.3390/healthcare12242502 . Zeng J, Li T, Pan Z, Liu Q, He J, Cai X, et al. Role of TyG, TyG-BMI and METS-IR in osteoporosis risk among older men: a retrospective cohort study. Asia Pac J Clin Nutr. 2025;34(3):477–85. 10.6133/apjcn.202506_34(3).0021 . Chen H, Hu J, Li J, Li Q, Lan L. Association between triglyceride-glucose index and femoral bone mineral density in community-dwelling, nondiabetic men and women: a NHANES analysis of 1,928 US individuals. Menopause. 2024;31(7):626–33. 10.1097/GME.0000000000002374 . Xuan X, Sun R, Peng C, Liu L, Huang T, Huang C. The nonlinear association between triglyceride glucose-body mass index and femoral neck BMD in nondiabetic elderly men: NHANES 2005-March 2020. PLoS ONE. 2024;19(1):e0296935. 10.1371/journal.pone.0296935 . Lai T, Su Z, Chen R, Luo G, Xu S, Fang H, et al. The association between different insulin resistance indexes and bone health in the elderly. PLoS ONE. 2025;20(2):e0318356. 10.1371/journal.pone.0318356 . Wen Z, Li Y, Xu L, Yue C, Wang Q, Chen R, et al. Triglyceride Glucose-Body Mass Index Is a Reliable Indicator of Bone Mineral Density and Risk of Osteoporotic Fracture in Middle-Aged and Elderly Nondiabetic Chinese Individuals. J Clin Med. 2022;11(19). 10.3390/jcm11195694 . Lloyd JT, Alley DE, Hawkes WG, Hochberg MC, Waldstein SR, Orwig DL. Body mass index is positively associated with bone mineral density in US older adults. Arch Osteoporos. 2014;9:175. 10.1007/s11657-014-0175-2 . Yan J, Herzog JW, Tsang K, Brennan CA, Bower MA, Garrett WS, et al. Gut microbiota induce IGF-1 and promote bone formation and growth. Proc Natl Acad Sci U S A. 2016;113(47):E7554–63. 10.1073/pnas.1607235113 . Oldroyd A, Dubey S. The association between bone mineral density and higher body mass index in men. Int J Clin Pract. 2015;69(1):145–7. 10.1111/ijcp.12523 . Wahrenberg H, Hertel K, Leijonhufvud BM, Persson LG, Toft E, Arner P. Use of waist circumference to predict insulin resistance: retrospective study. BMJ. 2005;330(7504):1363–4. 10.1136/bmj.38429.473310.AE . Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006;444(7121):840–6. 10.1038/nature05482 . Sridharan K, Cherian KE, Kurian ME, Asha HS, Paul TV, Kapoor N. Utility of anthropometric indicators in predicting osteoporosis in ambulant community dwelling rural postmenopausal women from southern India. Trop Doct. 2020;50(3):228–32. 10.1177/0049475520922769 . Romagnoli E, Lubrano C, Carnevale V, Costantini D, Nieddu L, Morano S, et al. Assessment of trabecular bone score (TBS) in overweight/obese men: effect of metabolic and anthropometric factors. Endocrine. 2016;54(2):342–7. 10.1007/s12020-016-0857-1 . Shieh A, Greendale GA, Cauley JA, Karvonen-Gutierriez C, Harlow SD, Finkelstein JS, et al. Prediabetes and insulin resistance are associated with lower trabecular bone score (TBS): cross-sectional results from the Study of Women's Health Across the Nation TBS Study. Osteoporos Int. 2022;33(6):1365–72. 10.1007/s00198-022-06325-x . Table 1 Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8964930","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":637775812,"identity":"098e5b00-3957-4bee-8b75-4fff2c88d0f4","order_by":0,"name":"Shahrzad Mohseni","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Shahrzad","middleName":"","lastName":"Mohseni","suffix":""},{"id":637775813,"identity":"9b21a811-7e2f-4c68-8bda-4705f9aed641","order_by":1,"name":"Kazem Khalagi","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Kazem","middleName":"","lastName":"Khalagi","suffix":""},{"id":637775814,"identity":"09e6835c-779e-481e-871b-fcb12172e214","order_by":2,"name":"Alireza Amanollahi","email":"","orcid":"","institution":"Iran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Alireza","middleName":"","lastName":"Amanollahi","suffix":""},{"id":637775815,"identity":"366ae7bc-20a1-43ab-bd52-975948e113a2","order_by":3,"name":"Noushin Fahimfar","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Noushin","middleName":"","lastName":"Fahimfar","suffix":""},{"id":637775816,"identity":"0fd3dcfb-31c6-48f1-a4e0-19b93a5e7786","order_by":4,"name":"Mahnaz Pejman Sani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYNACAxsGNhSBBMJa0iBaDhCvheEwhDqAVxEU6M5uf/i5oOC8PZ908wPmj23b7BnYDz9geLgHtxazO2eMpWcY3E5skzlmwHCw7XZiA0+aAUPCMzxabuQwSPMY3E5gk0gAawH6IgfoFzxONLuR/vg3j8E5ezaJ9A8gLfYM/G8IaUkwA9pygLFNIgdsC2ODBCFb7pwxs+YxSE4Eaik4cOYc0FMSzwwO4NVyu/3xbZ4/dvbyM9I3Pqgou23Pz5/88OEPPFoYJJDYYHVsDITiRwKv7CgYBaNgFIwCIAAAVbFQ4LttJZIAAAAASUVORK5CYII=","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Mahnaz","middleName":"Pejman","lastName":"Sani","suffix":""},{"id":637775817,"identity":"7c2e0835-0633-4cdf-8d35-f61903b20ef6","order_by":5,"name":"Iraj Nabipour","email":"","orcid":"","institution":"Bushehr University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Iraj","middleName":"","lastName":"Nabipour","suffix":""},{"id":637775818,"identity":"df81628a-b710-4445-8833-205c3683dc36","order_by":6,"name":"Afshin Ostovar","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Afshin","middleName":"","lastName":"Ostovar","suffix":""}],"badges":[],"createdAt":"2026-02-25 08:08:53","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8964930/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8964930/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109205536,"identity":"70e37cd6-1bff-4729-9029-17ff5b29a410","added_by":"auto","created_at":"2026-05-13 15:05:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":311441,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8964930/v1/86ddd83d-122a-472a-bfb0-3170aba5185c.pdf"},{"id":109182936,"identity":"7f65ca0a-7d29-4625-a3f2-5a2d50006f8e","added_by":"auto","created_at":"2026-05-13 10:31:24","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18044,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8964930/v1/472ee1b7596ea997630fb52d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe association of the TyG index-related parameters and bone health status in men aged 50 and over: a cross-sectional analysis of Bushehr Elderly Health (BEH) Program\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOsteoporosis, is a metabolic bone disorder characterized by low bone mineral density and deterioration in the microarchitecture of bone tissue, resulted in bone fragility and susceptibility to fracture [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The global prevalence of osteoporosis is 18.3% (11.7% in men and 23.1% in women) and is more common in developing countries [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to the Osteoporosis Diagnostic Guidelines, the prevalence of osteoporosis rises nearly exponentially in individuals over the age of 50 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A pooled meta-analysis among the general population\u0026thinsp;\u0026ge;\u0026thinsp;50 years old in Iran found the prevalence of osteoporosis to be 25% in men and to be as high as 38% in women [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], which is higher than the global prevalence.\u003c/p\u003e \u003cp\u003eInsulin impacts bone remodeling by regulating both the formation of bone through osteoblasts and the resorption of bone by osteoclasts[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Insulin resistance (IR) refers to the condition in which peripheral tissues are unable to respond to insulin[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Whether IR can affect bone metabolism remains unclear. Findings from recent research investigating the association between IR and osteoporosis, are inconsistent. While the gold standard method for assessing insulin resistance is the hyperinsulinemic-euglycemic clamp technique, and Homeostatic Model of Insulin Resistance (HOMA-IR), these techniques are complex, time-consuming, and are not feasible for routine clinical practice[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs an alternative approach for assessing IR, the triglyceride-glucose (TyG) index- which combines using available clinical laboratory values (fasting triglyceride levels and fasting plasma glucose)- has been proposed as a cost-effective, non-invasive and highly sensitive marker [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. It has been shown that, TyG may have better performance in evaluating IR than HOMA-IR [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Furthermore, it is worth noting that individuals with IR, often suffer from obesity[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], a condition that can affect bone health[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Existing evidence reveals that IR and obesity are associated with bone mineral density (BMD) and osteoporosis [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Additionally, in recent years several researchers have stated that the combination of the TyG index with obesity related indices (e.g., TyG-body mass index [BMI], TyG-waist circumference [WC] and TyG-waist to height ratio [WHtR]) may superior to TyG alone to identify IR[\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, the evidence regarding the advantage of TyG and its related indices in evaluating BMD is scarce and inconsistence.\u003c/p\u003e \u003cp\u003eDue to the higher incidence rate of osteoporosis in women aged 50 years and over, the larger body of evidence are focused on older adult women, with less emphasis on men. However, some evidence indicates that osteoporosis complications are more common in men than women[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHence, we conducted this study to evaluate the association between TyG and its related parameters with bone health, as surrogate markers of IR and bone health among men over 50 years living in Bushehr, Iran, utilizing data from the second recruitment of the Bushehr Elderly Health (BEH) program. To our knowledge, this is the first study to assess the relationships between TyG-related parameters and both BMD and trabecular bone score (TBS). Moreover, our novel approach evaluates TyG combined with central obesity indices simultaneously, providing insights into the interplay of insulin resistance, adiposity, and bone health in men.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThe present study was a cross-sectional analysis of 851 male participants over 50 years of age using findings from the second recruitment of the BEH program (PoCOsteo study). BEH program is a prospective cohort study conducted by the Endocrinology and Metabolism Research Institute (EMRI) at Tehran University of Medical Sciences (TUMS), and Persian Gulf Marine Biotechnology Research Centre (PGTMRC) at Bushehr University of Medical Sciences. BEH program aimed to investigate the prevalence and incidence of non-communicable diseases (NCDs) and their risk factors among the elderly population [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The second recruitment of the BEH program (PoCOsteo study) was implemented in 2018\u0026ndash;2019 and adds 2000 new sample aged\u0026thinsp;\u0026ge;\u0026thinsp;50 years to the BPH program. The study population consisted of residents of Bushehr city aged 50 and over, who were selected using a multi-stage stratified cluster sampling method. Trained interviewers collected information on age, education level, medical history, tobacco smoking (cigarettes or water pipes) and medication use through a comprehensive, valid questionnaire. The height and weight of individuals were measured by a fixed stadiometer and a digital scale after wearing light clothes and taking the shoes off. Waist circumferences was measured using a flexible and fixed elastic band at the midpoint between the last rib and the iliac crest. After overnight fasting for 8\u0026ndash;12-hour, 20 ml of venous blood sampling were obtained. Commercial kits (Pars Azmoon, Karaj, Iran) were used to total cholesterol, high density lipoprotein- cholesterol (HDL-C), low density lipoprotein- cholesterol (LDL-C), triglycerides, blood urea nitrogen (BUN), alkaline phosphatase (ALP), and serum 25-hydroxy vitamin D3 concentration.\u003c/p\u003e \u003cp\u003e All participants signed a written informed. The detailed protocol and methodology of the PoCOsteo study has described elsewhere [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eParticipants who had incomplete data and invalid data were excluded from the analysis.\u003c/p\u003e \u003cp\u003e The protocol of the current study was reviewed and accepted by Ethics Committee of the Endocrinology and Metabolism Research Institute (ID code: IR.TUMS.EMRI.REC.1403.072). This study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssessment of bone mineral density and trabecular bone score\u003c/h3\u003e\n\u003cp\u003eFor all participants, bone quantity and quality were assessed through bone mineral density (BMD) measurements and trabecular bone score (TBS), respectively. BMD was evaluated at the lumbar spine, total hip, and femoral neck using a dual-energy X-ray absorptiometry (DXA) system (Hologic, Bedford, MA, USA). Participants were categorized according to their T-score values based on WHO definitions [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The reference population for T-score calculation is bone mass at each site in young Caucasian women. Those with a T-score of 2.5 SD or more below reference mean (\u0026minus;\u0026thinsp;2.5 and lower) in at least one site were classified as osteoporotic, and others as non-osteoporotic. Additionally, we considered individuals with a T-score lower than 1 SD below the reference mean (\u0026minus;\u0026thinsp;1 or lower) at each site as having low BMD, encompassing both osteopenia and osteoporosis.\u003c/p\u003e\n\u003ch3\u003eDefinition of terms\u003c/h3\u003e\n\u003cp\u003eBMI was calculated by dividing weight in kilograms by the square of height in meters. Participants who were smoking cigarettes daily or occasionally and those who used hookah or pipes were classified as current smokers.\u003c/p\u003e \u003cp\u003eWaist-to-height ratio (WHtR) was defined as WC (cm) divided by body height (m) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe TyG related indices were calculated as follows:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTyG index\u0026thinsp;=\u0026thinsp;Ln [TG (mg/dL) \u0026times; FPG (mg/dL)]/2 [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTyG-BMI\u0026thinsp;=\u0026thinsp;TyG \u0026times; BMI (kg/m\u003csup\u003e2\u003c/sup\u003e) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTyG-WHtR\u0026thinsp;=\u0026thinsp;TyG \u0026times; WHtR [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTyG-WC\u0026thinsp;=\u0026thinsp;TyG \u0026times; WC (cm)[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eQuantitative variables were described as means with standard deviations, and categorical variables were presented as counts and percentages. To compare continuous variables and categorical variables between study groups, independent t-tests and chi-square tests were applied, with the assumptions of normality and homogeneity of variances verified. Associations between study outcomes (osteoporosis, low BMD, TBS L1\u0026ndash;L4, BMDs of lumbar spine (L1\u0026ndash;L4), total hip, and femoral neck) and independent variables (TyG, TyG-BMI, TyG-WC, and TyG-WHtR) were assessed using linear and logistic regression models, depending on the outcome type. Additional models were estimated adjusting for potential confounders based on the literature review. Collinearity among predictors and residual behavior was also assessed. Variance Inflation Factor (VIF) was used to test collinearity between variables and residual model also had a mean of zero and a standard deviation of 1.\u003c/p\u003e \u003cp\u003eAll statistical analyses were conducted at a significance level of 0.05 using Stata software.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eClinical characteristics of the study population\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the demographic characteristic, clinical and biochemical data of study population according to the osteoporosis status. A total of 851 male participants of \u0026gt;\u0026thinsp;50 years were included in the analysis.\u003c/p\u003e\n \u003cp\u003eThe mean age of the subjects was 62.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 years of whom 151 (17.7%) had osteoporosis. Compared to non-osteoporotic group, those with osteoporosis were likely to be older and being more smoker, exhibited a lower educational level, had lower BMI and waist circumference, and presented decreased levels of TG, TyG index, TyG-BMI, TyG-WC, and TyG-WHtR. (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eAssociation of TyG-index related parameters with BMD\u003c/h3\u003e\n\u003cp\u003eThe association between TyG-index related parameters and BMD status are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. In simple regression model, it was revealed a positive association between these four indices and BMD at lumbar spine (L1-L4), total hip, and femoral neck (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, after adjusting for confounding factors, all of the associations remained statistically significant, except for TyG-WHtR, which exhibited no association with BMD at each site. After adjusting for all confounding factors, one-unit increases in TyG, TyG-BMI, and TyG-WC was associated with 0.0661 g/cm\u003csup\u003e2\u003c/sup\u003e, 0.0012 g/cm\u003csup\u003e2\u003c/sup\u003e, and 0.0002 g/ cm\u003csup\u003e2\u003c/sup\u003e increase in lumbar spine BMD, respectively. One-unit increases in TyG, TyG-BMI, and TyG-WC was associated with 0.0499 g/cm\u003csup\u003e2\u003c/sup\u003e, 0.001 g/cm\u003csup\u003e2,\u003c/sup\u003e and 0.0001 g/cm\u003csup\u003e2\u003c/sup\u003e increase in total hip BMD. Finally, one-unit increases in TyG, TyG-BMI, and TyG-WC was associated with 0.0373 g/cm\u003csup\u003e2\u003c/sup\u003e, 0.0008 g/cm\u003csup\u003e2\u003c/sup\u003e, and 0.0001 g/cm\u003csup\u003e2\u003c/sup\u003e increase in femoral neck BMD.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe association between TyG-index related parameters and bone mineral density among study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ecrude\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eadjusted\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026szlig; (%95 CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026szlig; (%95 CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eLumbar spine\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(L1-L4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.042(0.024, 0.059)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0661(0.0355, 0.0967)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-BMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0012(0.001, 0.0015)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0012(0.001, 0.0014)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-WC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0004(0.0003, 0.0005)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0002(0.0001, 0.0003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-WHtR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.060(0.046, 0.074)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0082(-0.0146, 0.0311)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.480\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eTotal hip\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.038(0.023, 0.054)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0499(0.0248, 0.0750)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-BMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0012(0.001, 0.0014)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001(0.0008, 0.0012)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-WC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0003(0.0002, 0.0004)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0001(0.00004, 0.0002)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-WHtR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.048(0.036, 0.060)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0029(-0.0157, 0.0217)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.756\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eFemoral neck\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.033(0.018, 0.047)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0373(0.0139, 0.0607)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-BMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001(0.0008, 0.0012)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0008(0.0006, 0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-WC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0003(0.0002, 0.0004)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0001(0.00002, 0.0002)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-WHtR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.038(0.026, 0.049)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.0039(-0.0214, 0.0134)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.654\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e*Adjusted for Age, BUN, ALP, HDL-C, LDL-C, Cholesterol, vitamin D, education, smoking, BMI (except for TyG-BMI).\u003c/p\u003e \u003cp\u003eAbbreviations: CI, Confidence interval; TyG, Triglyceride-glucose; BMI, body mass index; WC, Waist circumference; WHtR, Waist-to-height ratio.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eAssociation of TyG-index related parameters with TBS\u003c/h3\u003e\n\u003cp\u003eThe association between TyG, TyG-BMI, TyG-WC, and TyG-WHtR w TBS are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. In the crude model, all indices except TyG showed significant negative associations. After adjusting for confounding factors, all of the indices exhibited significant associations with TBS, except for TyG-WC which showed no associations. After adjusting for confounding factors, one-unit increases in TyG was associated with 0.0129 g/cm\u003csup\u003e2\u003c/sup\u003e increases in TBS, while one-unit increases in TyG -BMI and TyG-WHtR was associated with 0.0005 g/cm\u003csup\u003e2\u003c/sup\u003e and 0.0454 g/cm\u003csup\u003e2\u003c/sup\u003e decreases in TBS, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between TyG-index related parameters and TBS among study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ecrude\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eadjusted\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026szlig; (%95 CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026szlig; (%95 CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eTBS\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(\u003c/b\u003eL1-L4\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.005(-0.005, 0.015)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0129(0.0027, 0.0231)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-BMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.0004(-0.0006, -0.0003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.0005(-0.0006, -0.0004)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-WC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.00017(-0.00022, -0.00012)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.00004(-0.0001, 0.00003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-WHtR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.034(-0.042, -0.025)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.0454(-0.0549, -0.0359)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e*Adjusted for Age, BUN, ALP, HDL-C, LDL-C, Cholesterol, vitamin D, education, smoking, BMI (except for TyG-BMI).\u003c/p\u003e \u003cp\u003eAbbreviations: CI, Confidence interval; TBS, Trabecular bone score; TyG, Triglyceride-glucose; BMI, body mass index; WC,Waist circumference; WHtR, Waist-to-height ratio\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAssociation between TyG-index related parameters and osteoporosis/low BMD\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e displays the associations of osteoporosis and low BMD with TyG indices. Logistic regression analysis revealed statistically significant association across both crude and adjusted models with osteoporosis and low BMD except for adjusted TyG-WHtR. It was revealed that higher TyG index, TyG-BMI and TyG-WC may be related with lower odds of osteoporosis or low BMD even after adjusting for confounding factors.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regression analysis assessed the association between TyG-index related parameters with osteoporosis and low BMD\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ecrude\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eadjusted\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR (%95 CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR (%95 CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eOsteoporosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.537(0.391, 0.737)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.676(0.482, 0.949)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-BMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.982(0.977, 0.986)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.982(0.977, 0.987)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-WC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.994(0.992, 0.996)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.996(0.994, 0.999)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-WHtR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.512(0.398, 0.658)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.004(0.651, 1.546)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.985\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eLow BMD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.693(0.551, 0.874)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.433(0.269, 0.696)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-BMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.987(0.984, 0.991)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.987(0.983, 0.991)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-WC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.996(0.995, 0.997)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.995(0.994, 0.997)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTyG-WHtR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.638(0.525, 0.776)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.079(0.765, 1.521)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.663\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e*Adjusted for Age, BUN, ALP, HDL-C, LDL-C, Cholesterol, vitamin D, education, smoking, BMI (except for TyG-BMI).\u003c/p\u003e \u003cp\u003eAbbreviations: OR, Odds ratio; CI, Confidence interval; TyG, Triglyceride-glucose; BMI, Body mass index; WC, Waist circumference; WHtR, Waist-to-height ratio; BMD, Bone mineral density\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis cross-sectional study investigated the associations between TyG-index and its related parameters (TyG-BMI, TyG-WC, TyG-WHtR) with BMD, osteoporosis, and TBS in men over 50 years from the Bushehr Elderly Health (BEH) program. The findings demonstrated a significant relationship where higher TyG, TyG-BMI, and TyG-WC levels were positively associated with BMD at lumbar spine, total hip, and femoral neck, and inversely associated with osteoporosis and low BMD. This suggests that these indices may serve as useful surrogate markers for bone health assessment in older men. Moreover, we found that TyG had significant positive association with TBS, while TyG-BMI and TyG-WHtR exhibited significant negative associations with TBS.\u003c/p\u003e \u003cp\u003eBeyond genetic factors, age, and lifestyle conditions[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], recent research has highlighted the significant association of impaired glucose and lipid metabolism with bone metabolism [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. However, previous studies have highlighted the limited predictive ability of TG or HDL-C and have shown inconsistent associations between these two parameters and the risk of osteoporosis[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Consequently, composite indices incorporating glucose and lipid parameters including TyG, TyG-BMI, TyG-WC, and TyG-WHtR have been created that all are reliable surrogate markers of IR[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Recently, a growing number of studies have been published focusing on novel glucolipid metabolism-related markers aimed at improving predictive accuracy[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe underlying mechanism between bone and glucose metabolism is complex and not completely understood. Insulin signaling regulates osteoblast proliferation while inhibiting osteoclasts activity, resulting in bone formation. In the state of IR, the insulin sensitivity reduces, causing the pancreas to increase insulin secretion and leading to hyperinsulinemia. This elevated insulin level further enhances bone mass[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, hyperinsulinemia can negatively affect sex hormone\u0026ndash;binding globulin, that resulted in higher levels of free sex hormones, which might help protect against bone loss[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. On the other hand, elevated levels of proinflammatory cytokines including IL-6, IL-1 and TNF-α are frequently observed in individuals with insulin resistance. These mediators promote osteoclasts differentiation and activity via stimulate the RANK/RANKL/OPG signaling cascade, and accelerating bone loss [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This may account for the observed inconsistent or insignificant associations between TyG index and BMD reported by various studies.\u003c/p\u003e \u003cp\u003eResearch has revealed a strong link between a higher TyG index and changes in BMD among diverse groups, emphasizing the complex relationship between metabolic health and bone strength [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. While some cross-sectional studies indicated that a higher TyG index, is associated with reduced BMD and a greater risk of osteoporosis[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], some others found no significant correlation or proposed a possible protective effect in certain populations\u003csup\u003e[38, 39]\u003c/sup\u003e. Consistent with our findings, Zeng et al.[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] in a cohort of 1,622 middle-aged and older Chinese men, followed from 2015 to 2022, found that higher values of TyG, were associated with a reduced risk [hazard ratios, 95%CI: 0.573 (0.336\u0026ndash;0.976)] of developing osteoporosis. Yoon et al.[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], found a negative relationship between the TyG index and femoral neck BMD in Korean non-diabetic men population aged\u0026thinsp;\u0026ge;\u0026thinsp;50 years. Likewise, Zhan et al.[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] analyzed data of 3646 subjects (53.6% male) aged\u0026thinsp;\u0026ge;\u0026thinsp;20 years from National Health and Nutrition Examination Survey (NHANS). Their findings revealed a negative correlation between TyG index and lumbar spine BMD among 1956 men (β = \u0026minus;0.017, 95% CI: \u0026minus; 0.028, \u0026minus; 0.005). Tian et al.[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] identified a significant positive association between TyG index and total BMD (excluding post-menopausal women), with regression coefficients rising when the TyG index exceeded 9.106. However, after adjusting for confounding factors, this association lost among men. Chen et al.[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] using data from NHANES (2005\u0026ndash;2018), found no association between TyG index and femoral neck BMD in non-diabetic men and post-menopausal women aged\u0026thinsp;\u0026ge;\u0026thinsp;50 years, as well as the odds for low BMD. These discrepancies may be contributed to variations in the age of study populations, demographics and adjusting factors.\u003c/p\u003e \u003cp\u003eWe also found a positive association between the TyG-BMI index and BMD across all sites, and further identified its protective role against osteoporosis and low BMD. Consistent with our findings, Xuan et al.[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] examined TyG-BMI\u0026rsquo;s relationship with femoral neck BMD encompassing 1182 non-diabetic men of 50 years and more using NHANES data. Their analysis demonstrated a positive, and nonlinear relationship between TyG-BMI and femoral neck BMD, indicating that increased insulin resistance combined with BMI may improve bone density. Lai et al. [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e] in a recent cross-sectional study in 1,303 adults aged 50\u0026thinsp;\u0026ge;\u0026thinsp;years from the NHANES (2007\u0026ndash;2014) revealed that TyG-BMI had significant positive association with BMD at femoral neck, total hip and lumbar spine region and a negative association with osteopenia/osteoporosis risks in both genders. These findings are supported by another research [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Likewise, Zeng et al.[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] reported that TyG-BMI was associated with reduced incidence of male osteoporosis. The protective effect noted may partly reflect the mechanical loading exerted by higher body mass, which stimulates osteoblastic activity, and promoting bone formation [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Another mechanism to explain is the elevation of serum insulin-like growth factor-1 (IGF-1) in overweight/obese individuals that promoting bone growth and mineralization[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. These explanations support the hypothesis that moderate obesity could enhance bone density, consistent with existing literature indicating that a BMI of up to 35 kg/m\u0026sup2; beneficially affecting BMD in men[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEvidence regarding the association of TyG-WC and BMD status are limited. The TyG-WC index, which incorporates waist circumference, is a reliable tool for assessing the risk of IR linked to abdominal obesity. High waist circumference, indicator of body fat distribution, specifically visceral fat contributes to the release of pro-inflammatory cytokines and altered lipid metabolism, both of which worsen insulin sensitivity and increase IR risk[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. In the present study, after adjusting for confounders, we found that TyG-WC was positively associated with BMD at each site. Moreover, TyG-WC was associated with lower risk of osteoporosis and low BMD. Consistent with our findings, Lai et al. [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e] similarly reported positive associations of TyG-WC with BMD and a protective effect on bone loss in older males and females. These findings suggest TyG-WC could provide incremental predictive value beyond TyG alone for bone health assessment in clinical practice.\u003c/p\u003e \u003cp\u003eIn the present study no correlation was found between TyG-WHtR and BMD as well as osteoporosis/low BMD after adjusting for confounding factors. Research on the association between the TyG- WHtR index and BMD is restricted with inconsistent results. Lai et al. [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e] demonstrated that TyG-WHtR have a significant positive relationship with BMD and a negative relationship with osteopenia/osteoporosis in the lumbar spine, total hip and femoral neck region among men and women aged\u0026thinsp;\u0026ge;\u0026thinsp;50 years. Tian et al.[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] evaluated NHANES data (2011\u0026ndash;2018) with 5456 participants (mean age: 30.33\u0026thinsp;\u0026plusmn;\u0026thinsp;13.55 years, 55.65% males) and reported a significant protective effect of TyG- WHtR against bone loss. The regression coefficient rised when TyG- WHtR exceeded the threshold of 4.065 and when TyG-WHtR exceeded its threshold, the regression coefficient decreases. However, like our findings after subgroup analysis, the significancy lost among male gender. WHtR measures waist circumference relative to height and serves as an effective indicator of central adiposity. In terms of bone health, prior studies suggest that central obesity can contribute to bone loss by triggering chronic inflammation, disrupting metabolism of the adipose tissue, and causing IR, which collectively increase the risk of osteoporosis[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo our knowledge this is the first study that assessment the relationships between TyG-related parameters and TBS (L1-L4) status. It was revealed that TyG-BMI and TyG- WHtR exhibited a negative association with TBS after adjustment, indicating potential adverse effects on bone microarchitecture despite favorable correlations with BMD. The exact mechanism of the associations of these indices with TBS are not explained, but it might be contributed to changes in glucose regulation and sex hormone levels[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Moreover, as these parameters are surrogate markers of insulin resistance, it has been shown that insulin resistance is associated with worse trabecular bone quality[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Future longitudinal studies are required to clarify these relationships and potential causal pathways.\u003c/p\u003e \u003cp\u003e Main strengths of the present study include large community-based sample, comprehensive adjustment for confounders, and focus on men aged 50 and over as guidelines indicate that the likelihood of osteoporosis rises abruptly after age 50, which enhances the relevance and clinical significance of our research. Finally, we applied a broadly important confounding factors, that enhance the reliability of the findings. Our results made the foundation for further longitudinal cohort studies. However, the cross-sectional design precludes causal implication and reverse causality cannot be excluded.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, this study highlighted that the TyG index-related parameters especially TyG-BMI and TyG-WC, are positively associated with BMD and may serve as cost-effective, surrogate markers for bone health and osteoporosis risk stratification in older adult men. These findings underscore the complex interaction between insulin resistance, adiposity, and skeletal health. Longitudinal research is warranted to clarify causal relationships and explore underlying biological mechanisms. incorporating these indices into clinical practice may improve early identification and management of osteoporosis in aging male populations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki. The protocol of the current study was reviewed and accepted by Ethics Committee of the Endocrinology and Metabolism Research Institute (ID code: IR.TUMS.EMRI.REC.1403.072).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in this study are from the Bushehr Elderly Health (BEH) program, a population-based cohort study owned and governed by the Ministry of Health and Medical Education of the Islamic Republic of Iran through the Persian Cohort and Biobank regulations. Due to ethical and legal restrictions on sharing potentially identifiable human data and national regulations, the raw dataset cannot be made publicly available. However, the de-identified minimal dataset underlying the results of this study is available upon reasonable request to the project administrator.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003eethic code: IR.TUMS.EMRI.REC.1403.072), was a secondary analysis of data from the Bushehr Elderly Health (BEH) Program (ethic code: IR.TUMS.EMRI.REC.1394.0036). \u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSHM:\u0026nbsp;\u003c/strong\u003eWriting (original draft, and editing); \u003cstrong\u003eKK:\u003c/strong\u003e\u0026nbsp; Methodology, validation\u003cstrong\u003e, AA:\u0026nbsp;\u003c/strong\u003eFormal analysis;\u003cstrong\u003e\u0026nbsp;NF:\u0026nbsp;\u003c/strong\u003eValidation, supervision\u003cstrong\u003e;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eMPS:\u003c/strong\u003e\u0026nbsp; Conceptualization; supervision; \u003cstrong\u003eIN and AO:\u0026nbsp;\u003c/strong\u003eProject administration. All authors reviewed the manuscript and approved the final version.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNot applicable\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eQaseem A, Forciea MA, McLean RM, Denberg TD, Clinical Guidelines Committee of the American College of P, Barry MJ, et al. Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update From the American College of Physicians. Ann Intern Med. 2017;166(11):818\u0026ndash;39. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7326/M15-1361\u003c/span\u003e\u003cspan address=\"10.7326/M15-1361\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalari N, Ghasemi H, Mohammadi L, Behzadi MH, Rabieenia E, Shohaimi S, et al. The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis. J Orthop Surg Res. 2021;16:1\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVondracek SF, Linnebur SA. Diagnosis and management of osteoporosis in the older senior. Clin Interv Aging. 2009;4:121\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/cia.s4965\u003c/span\u003e\u003cspan address=\"10.2147/cia.s4965\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClynes MA, Harvey NC, Curtis EM, Fuggle NR, Dennison EM, Cooper C. The epidemiology of osteoporosis. Br Med Bull. 2020;133(1):105\u0026ndash;17. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/bmb/ldaa005\u003c/span\u003e\u003cspan address=\"10.1093/bmb/ldaa005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFahimfar N, Hesari E, Mansourzadeh MJ, Khalagi K, Sanjari M, Hajivalizadeh S, et al. Prevalence of osteoporosis in the Iranian population: a systematic review and meta-analysis. J Diabetes Metab Disord. 2024;23(1):229\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40200-023-01352-9\u003c/span\u003e\u003cspan address=\"10.1007/s40200-023-01352-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConte C, Epstein S, Napoli N. Insulin resistance and bone: a biological partnership. Acta Diabetol. 2018;55(4):305\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00592-018-1101-7\u003c/span\u003e\u003cspan address=\"10.1007/s00592-018-1101-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaffner SM, Valdez RA, Hazuda HP, Mitchell BD, Morales PA, Stern MP. Prospective analysis of the insulin-resistance syndrome (syndrome X). Diabetes. 1992;41(6):715\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2337/diab.41.6.715\u003c/span\u003e\u003cspan address=\"10.2337/diab.41.6.715\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePan J, Huang X, Wang Q, Sun J, Zhai Z, Mo J, et al. Triglyceride Glucose Index is Strongly Associated with a Fragility Fracture in Postmenopausal Elderly Females with Type 2 Diabetes Mellitus Combined with Osteoporosis: A 6-Year Follow-Up Study. Clin Interv Aging. 2023;18:1841\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/CIA.S434194\u003c/span\u003e\u003cspan address=\"10.2147/CIA.S434194\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimental-Mendia LE, Rodriguez-Moran M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 2008;6(4):299\u0026ndash;304. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1089/met.2008.0034\u003c/span\u003e\u003cspan address=\"10.1089/met.2008.0034\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohseni S, Sani MP. Association Between Triglyceride-glucose Related Indices and Bone Health: A Review Study. Iran J Diabetes Metabolism. 2025;25(4):299\u0026ndash;307.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSon DH, Lee HS, Lee YJ, Lee JH, Han JH. Comparison of triglyceride-glucose index and HOMA-IR for predicting prevalence and incidence of metabolic syndrome. Nutr Metab Cardiovasc Dis. 2022;32(3):596\u0026ndash;604. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.numecd.2021.11.017\u003c/span\u003e\u003cspan address=\"10.1016/j.numecd.2021.11.017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuren Garg S, Kushwaha K, Dubey R, Gupta J. Association between obesity, inflammation and insulin resistance: Insights into signaling pathways and therapeutic interventions. Diabetes Res Clin Pract. 2023;200:110691. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.diabres.2023.110691\u003c/span\u003e\u003cspan address=\"10.1016/j.diabres.2023.110691\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalermo A, Tuccinardi D, Defeudis G, Watanabe M, D'Onofrio L, Lauria Pantano A, et al. BMI and BMD: The Potential Interplay between Obesity and Bone Fragility. Int J Environ Res Public Health. 2016;13(6). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph13060544\u003c/span\u003e\u003cspan address=\"10.3390/ijerph13060544\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaimoun L, Mura T, Leprieur E, Avignon A, Mariano-Goulart D, Sultan A. Impact of obesity on bone mass throughout adult life: Influence of gender and severity of obesity. Bone. 2016;90:23\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.bone.2015.11.020\u003c/span\u003e\u003cspan address=\"10.1016/j.bone.2015.11.020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFu YH, Liu WJ, Lee CL, Wang JS. Associations of insulin resistance and insulin secretion with bone mineral density and osteoporosis in a general population. Front Endocrinol (Lausanne). 2022;13:971960. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fendo.2022.971960\u003c/span\u003e\u003cspan address=\"10.3389/fendo.2022.971960\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEr LK, Wu S, Chou HH, Hsu LA, Teng MS, Sun YC, et al. Triglyceride Glucose-Body Mass Index Is a Simple and Clinically Useful Surrogate Marker for Insulin Resistance in Nondiabetic Individuals. PLoS ONE. 2016;11(3):e0149731. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0149731\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0149731\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLim J, Kim J, Koo SH, Kwon GC. Comparison of triglyceride glucose index, and related parameters to predict insulin resistance in Korean adults: An analysis of the 2007\u0026ndash;2010 Korean National Health and Nutrition Examination Survey. PLoS ONE. 2019;14(3):e0212963. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0212963\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0212963\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim HS, Cho YK, Kim EH, Lee MJ, Jung CH, Park JY, et al. Triglyceride Glucose-Waist Circumference Is Superior to the Homeostasis Model Assessment of Insulin Resistance in Identifying Nonalcoholic Fatty Liver Disease in Healthy Subjects. J Clin Med. 2021;11(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm11010041\u003c/span\u003e\u003cspan address=\"10.3390/jcm11010041\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCenter JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. 1999;353(9156):878\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(98)09075-8\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(98)09075-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrewal S, Jawad AS. Morbidity associated with osteoporosis significant in older men. Trends Urol Men's Health. 2022;13(4):22\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/tre.868\u003c/span\u003e\u003cspan address=\"10.1002/tre.868\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShafiee G, Ostovar A, Heshmat R, Darabi H, Sharifi F, Raeisi A, et al. Bushehr Elderly Health (BEH) programme: study protocol and design of musculoskeletal system and cognitive function (stage II). BMJ Open. 2017;7(8):e013606. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2016-013606\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2016-013606\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhashayar P, Dimai HP, Moradi N, Fahimfar N, Gharibzadeh S, Ostovar A, et al. Protocol for a multicentre, prospective cohort study of clinical, proteomic and genomic patterns associated with osteoporosis to develop a multidimensional fracture assessment tool: the PoCOsteo Study. BMJ Open. 2020;10(9):e035363. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2019-035363\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2019-035363\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994;4(6):368\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/BF01622200\u003c/span\u003e\u003cspan address=\"10.1007/BF01622200\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNevill AM, Stewart AD, Olds T, Duncan MJ. A new waist-to-height ratio predicts abdominal adiposity in adults. Res Sports Med. 2020;28(1):15\u0026ndash;26. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/15438627.2018.1502183\u003c/span\u003e\u003cspan address=\"10.1080/15438627.2018.1502183\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuerrero-Romero F, Simental-Mendia LE, Gonzalez-Ortiz M, Martinez-Abundis E, Ramos-Zavala MG, Hernandez-Gonzalez SO, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010;95(7):3347\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1210/jc.2010-0288\u003c/span\u003e\u003cspan address=\"10.1210/jc.2010-0288\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalek M, Khamseh ME, Chehrehgosha H, Nobarani S, Alaei-Shahmiri F. Triglyceride glucose-waist to height ratio: a novel and effective marker for identifying hepatic steatosis in individuals with type 2 diabetes mellitus. Endocrine. 2021;74(3):538\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12020-021-02815-w\u003c/span\u003e\u003cspan address=\"10.1007/s12020-021-02815-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhamseh ME, Malek M, Abbasi R, Taheri H, Lahouti M, Alaei-Shahmiri F. Triglyceride Glucose Index and Related Parameters (Triglyceride Glucose-Body Mass Index and Triglyceride Glucose-Waist Circumference) Identify Nonalcoholic Fatty Liver and Liver Fibrosis in Individuals with Overweight/Obesity. Metab Syndr Relat Disord. 2021;19(3):167\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1089/met.2020.0109\u003c/span\u003e\u003cspan address=\"10.1089/met.2020.0109\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAfarideh M, Sartori-Valinotti JC, Tollefson MM. Association of Sun-Protective Behaviors With Bone Mineral Density and Osteoporotic Bone Fractures in US Adults. JAMA Dermatol. 2021;157(12):1437\u0026ndash;46. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamadermatol.2021.4143\u003c/span\u003e\u003cspan address=\"10.1001/jamadermatol.2021.4143\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou H, Li C, Song W, Wei M, Cui Y, Huang Q, et al. Increasing fasting glucose and fasting insulin associated with elevated bone mineral density-evidence from cross-sectional and MR studies. Osteoporos Int. 2021;32(6):1153\u0026ndash;64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00198-020-05762-w\u003c/span\u003e\u003cspan address=\"10.1007/s00198-020-05762-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang J, Qiu P, Wang Y, Zhao C, Fan S, Lin X. Association between serum high-density lipoprotein cholesterol and bone health in the general population: a large and multicenter study. Arch Osteoporos. 2019;14(1):36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11657-019-0579-0\u003c/span\u003e\u003cspan address=\"10.1007/s11657-019-0579-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhan H, Liu X, Piao S, Rong X, Guo J. Association between triglyceride-glucose index and bone mineral density in US adults: a cross sectional study. J Orthop Surg Res. 2023;18(1):810. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13018-023-04275-6\u003c/span\u003e\u003cspan address=\"10.1186/s13018-023-04275-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHou XZ, Lv YF, Li YS, Wu Q, Lv QY, Yang YT, et al. Association between different insulin resistance surrogates and all-cause mortality in patients with coronary heart disease and hypertension: NHANES longitudinal cohort study. Cardiovasc Diabetol. 2024;23(1):86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12933-024-02173-7\u003c/span\u003e\u003cspan address=\"10.1186/s12933-024-02173-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCui C, Qi Y, Song J, Shang X, Han T, Han N, et al. Comparison of triglyceride glucose index and modified triglyceride glucose indices in prediction of cardiovascular diseases in middle aged and older Chinese adults. Cardiovasc Diabetol. 2024;23(1):185. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12933-024-02278-z\u003c/span\u003e\u003cspan address=\"10.1186/s12933-024-02278-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi J, Ma C, Wang X, Li J, Liu P, Zhu M. Development and validation of a novel glucolipid metabolism-related nomogram to enhance the predictive performance for osteoporosis complications in prediabetic and diabetic patients. Lipids Health Dis. 2025;24(1):183. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12944-025-02602-w\u003c/span\u003e\u003cspan address=\"10.1186/s12944-025-02602-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBirkeland KI, Hanssen KF, Torjesen PA, Vaaler S. Level of sex hormone-binding globulin is positively correlated with insulin sensitivity in men with type 2 diabetes. J Clin Endocrinol Metab. 1993;76(2):275\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1210/jcem.76.2.8432768\u003c/span\u003e\u003cspan address=\"10.1210/jcem.76.2.8432768\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePonzetti M, Rucci N. Updates on Osteoimmunology: What's New on the Cross-Talk Between Bone and Immune System. Front Endocrinol (Lausanne). 2019;10:236. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fendo.2019.00236\u003c/span\u003e\u003cspan address=\"10.3389/fendo.2019.00236\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoon JH, Hong AR, Choi W, Park JY, Kim HK, Kang HC. Association of Triglyceride-Glucose Index with Bone Mineral Density in Non-diabetic Koreans: KNHANES 2008\u0026ndash;2011. Calcif Tissue Int. 2021;108(2):176\u0026ndash;87. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00223-020-00761-9\u003c/span\u003e\u003cspan address=\"10.1007/s00223-020-00761-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTian N, Chen S, Han H, Jin J, Li Z. Association between triglyceride glucose index and total bone mineral density: a cross-sectional study from NHANES 2011\u0026ndash;2018. Sci Rep. 2024;14(1):4208. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41598-024-54192-9\u003c/span\u003e\u003cspan address=\"10.1038/s41598-024-54192-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHung YT, Yu TH, Alizargar J. Insulin Resistance and Bone Mineral Density: A Comprehensive Examination Using UK Biobank Data. Healthc (Basel). 2024;12(24). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/healthcare12242502\u003c/span\u003e\u003cspan address=\"10.3390/healthcare12242502\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZeng J, Li T, Pan Z, Liu Q, He J, Cai X, et al. Role of TyG, TyG-BMI and METS-IR in osteoporosis risk among older men: a retrospective cohort study. Asia Pac J Clin Nutr. 2025;34(3):477\u0026ndash;85. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.6133/apjcn.202506_34(3).0021\u003c/span\u003e\u003cspan address=\"10.6133/apjcn.202506_34(3).0021\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen H, Hu J, Li J, Li Q, Lan L. Association between triglyceride-glucose index and femoral bone mineral density in community-dwelling, nondiabetic men and women: a NHANES analysis of 1,928 US individuals. Menopause. 2024;31(7):626\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/GME.0000000000002374\u003c/span\u003e\u003cspan address=\"10.1097/GME.0000000000002374\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXuan X, Sun R, Peng C, Liu L, Huang T, Huang C. The nonlinear association between triglyceride glucose-body mass index and femoral neck BMD in nondiabetic elderly men: NHANES 2005-March 2020. PLoS ONE. 2024;19(1):e0296935. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0296935\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0296935\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLai T, Su Z, Chen R, Luo G, Xu S, Fang H, et al. The association between different insulin resistance indexes and bone health in the elderly. PLoS ONE. 2025;20(2):e0318356. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0318356\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0318356\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWen Z, Li Y, Xu L, Yue C, Wang Q, Chen R, et al. Triglyceride Glucose-Body Mass Index Is a Reliable Indicator of Bone Mineral Density and Risk of Osteoporotic Fracture in Middle-Aged and Elderly Nondiabetic Chinese Individuals. J Clin Med. 2022;11(19). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm11195694\u003c/span\u003e\u003cspan address=\"10.3390/jcm11195694\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLloyd JT, Alley DE, Hawkes WG, Hochberg MC, Waldstein SR, Orwig DL. Body mass index is positively associated with bone mineral density in US older adults. Arch Osteoporos. 2014;9:175. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11657-014-0175-2\u003c/span\u003e\u003cspan address=\"10.1007/s11657-014-0175-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYan J, Herzog JW, Tsang K, Brennan CA, Bower MA, Garrett WS, et al. Gut microbiota induce IGF-1 and promote bone formation and growth. Proc Natl Acad Sci U S A. 2016;113(47):E7554\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1073/pnas.1607235113\u003c/span\u003e\u003cspan address=\"10.1073/pnas.1607235113\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOldroyd A, Dubey S. The association between bone mineral density and higher body mass index in men. Int J Clin Pract. 2015;69(1):145\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/ijcp.12523\u003c/span\u003e\u003cspan address=\"10.1111/ijcp.12523\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWahrenberg H, Hertel K, Leijonhufvud BM, Persson LG, Toft E, Arner P. Use of waist circumference to predict insulin resistance: retrospective study. BMJ. 2005;330(7504):1363\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmj.38429.473310.AE\u003c/span\u003e\u003cspan address=\"10.1136/bmj.38429.473310.AE\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006;444(7121):840\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/nature05482\u003c/span\u003e\u003cspan address=\"10.1038/nature05482\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSridharan K, Cherian KE, Kurian ME, Asha HS, Paul TV, Kapoor N. Utility of anthropometric indicators in predicting osteoporosis in ambulant community dwelling rural postmenopausal women from southern India. Trop Doct. 2020;50(3):228\u0026ndash;32. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0049475520922769\u003c/span\u003e\u003cspan address=\"10.1177/0049475520922769\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRomagnoli E, Lubrano C, Carnevale V, Costantini D, Nieddu L, Morano S, et al. Assessment of trabecular bone score (TBS) in overweight/obese men: effect of metabolic and anthropometric factors. Endocrine. 2016;54(2):342\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12020-016-0857-1\u003c/span\u003e\u003cspan address=\"10.1007/s12020-016-0857-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShieh A, Greendale GA, Cauley JA, Karvonen-Gutierriez C, Harlow SD, Finkelstein JS, et al. Prediabetes and insulin resistance are associated with lower trabecular bone score (TBS): cross-sectional results from the Study of Women's Health Across the Nation TBS Study. Osteoporos Int. 2022;33(6):1365\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00198-022-06325-x\u003c/span\u003e\u003cspan address=\"10.1007/s00198-022-06325-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"TyG, Bone mineral density, Trabecular bone score, Bone health, Osteoporosis, Iran","lastPublishedDoi":"10.21203/rs.3.rs-8964930/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8964930/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe triglyceride-glucose (TyG) index and its related parameters (TyG-BMI, TyG-WC, and TyG-WHtR) have emerged as sensitive and cost-effective markers of insulin resistance (IR). However, limited research has investigated the association between these parameters with bone health. This study aimed to evaluate the association between TyG and its related parameters with bone mineral density (BMD), as surrogate markers of IR and bone health among men over 50 years utilizing data from the Bushehr Elderly Health (BEH) program.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional analysis utilized data from the BEH Program involving 851 older adult men aged 50 years or more. Bone health was assessed using BMD measurements at the lumbar spine, total hip, and femoral neck, and trabecular bone score (TBS). Low BMD (osteopenia/osteoporosis) and osteoporosis were defined as a T-score lower than 1 standard deviation (SD) below the reference mean (\u0026minus;\u0026thinsp;1 or lower) and 2.5 SD or more below reference mean (\u0026minus;\u0026thinsp;2.5 and lower) in at least one site, respectively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age of the study participants was 62.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 years, of whom 151 (17.74%) had osteoporosis. Through multivariate linear and logistic regression analysis, TyG and its related parameters (except TyG-WHtR) exhibited a significant positive association with BMD and a negative association with osteoporosis/ low BMD at each bone site. Conversely, TyG-BMI and TyG-WHtR showed negative associations with TBS (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) after adjustment for confounding factors.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThese findings highlighted that TyG index-related parameters may serve as valuable markers in evaluating bone health in older adult men.\u003c/p\u003e","manuscriptTitle":"The association of the TyG index-related parameters and bone health status in men aged 50 and over: a cross-sectional analysis of Bushehr Elderly Health (BEH) Program","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-13 10:31:20","doi":"10.21203/rs.3.rs-8964930/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3f398556-2020-49f4-8ee2-2700da87dcff","owner":[],"postedDate":"May 13th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewersInvited","content":"20","date":"2026-05-05T20:55:15+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T10:31:20+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-13 10:31:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8964930","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8964930","identity":"rs-8964930","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}