Association of Life’s Essential 8 with femur osteoporosis among US adults: a cross-sectional study from NHANES

Association of Life’s Essential 8 with femur osteoporosis among US adults: a cross-sectional study from NHANES | 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 Article Association of Life’s Essential 8 with femur osteoporosis among US adults: a cross-sectional study from NHANES Xuecheng Liu, Kai Lv, Rilin Zhang, Jianghan Xu, Zhichao Ge, Qing Zhao, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5161501/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 Osteoporosis is a significant public health concern characterized by decreased bone mineral density and increased fracture risk, particularly among older adults. Lifestyle factors play a crucial role in bone health, and the American Heart Association’s Life’s Essential 8 score has been associated with various health outcomes. However, the relationship between LE8 scores and osteoporosis risk remains underexplored. We conducted a cross-sectional study among 6,748 participants aged 50 years and older from the National Health and Nutrition Examination Survey. Femur BMD was measured using dual-energy X-ray absorptiometry, and osteoporosis was defined according to the World Health Organization criteria. LE8 scores were calculated based on the American Heart Association’s guidelines, with scores categorized as low, moderate, or high. Multivariable logistic regression and modified Poisson regression with robust error variance were employed to assess the association between LE8 scores and osteoporosis risk. Higher LE8 scores were significantly associated with increased femur BMD and a reduced risk of osteoporosis. Compared to participants with low LE8 scores, those with moderate and high LE8 scores had significantly lower adjusted odds of osteoporosis (aOR: 0.62, 95% CI: 0.46-0.83; aOR: 0.53, 95% CI: 0.31-0.89, respectively). The adjusted relative risks (aRR) were also significantly lower for the moderate and high LE8 groups (aRR: 0.70, 95% CI: 0.56-0.86; aRR: 0.62, 95% CI: 0.42-0.92, respectively). A nonlinear relationship was observed between LE8 scores and BMD (P for nonlinearity < 0.001), indicating more substantial reductions in osteoporosis risk at higher LE8 scores. Subgroup analyses revealed that the protective effect of higher LE8 scores was more pronounced in non-hispanic whites and premenopausal women. These findings suggest LE8 scores are negatively and nonlinearly associated with osteoporosis risk among U.S. adults aged 50 and older. Health sciences/Medical research/Epidemiology Health sciences/Health care/Disease prevention/Lifestyle modification Osteoporosis Bone mineral density Adults Lifestyle factors Life’s Essential 8 Full Text Additional Declarations No competing interests reported. Supplementary Files supplementarymaterial.pdf 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-5161501","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":391024494,"identity":"9f361460-da37-4d51-95c3-092025aa2979","order_by":0,"name":"Xuecheng Liu","email":"","orcid":"","institution":"Yueyang Hospital of Integrated Traditional Chinese and Western Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xuecheng","middleName":"","lastName":"Liu","suffix":""},{"id":391024495,"identity":"45e1994a-094e-4efc-bd47-fd499c1cb14f","order_by":1,"name":"Kai Lv","email":"","orcid":"","institution":"Yueyang Hospital of Integrated Traditional Chinese and Western Medicine","correspondingAuthor":false,"prefix":"","firstName":"Kai","middleName":"","lastName":"Lv","suffix":""},{"id":391024496,"identity":"7b6bd30d-ca08-4092-9529-8c45c7de53a5","order_by":2,"name":"Rilin Zhang","email":"","orcid":"","institution":"Yueyang Hospital of Integrated Traditional Chinese and Western Medicine","correspondingAuthor":false,"prefix":"","firstName":"Rilin","middleName":"","lastName":"Zhang","suffix":""},{"id":391024497,"identity":"448840de-6892-4f6f-873f-a2fe0a491422","order_by":3,"name":"Jianghan Xu","email":"","orcid":"","institution":"Yueyang Hospital of Integrated Traditional Chinese and Western Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jianghan","middleName":"","lastName":"Xu","suffix":""},{"id":391024498,"identity":"7a31bc44-4d54-47df-8039-0ef90eab6d05","order_by":4,"name":"Zhichao Ge","email":"","orcid":"","institution":"Yueyang Hospital of Integrated Traditional Chinese and Western Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zhichao","middleName":"","lastName":"Ge","suffix":""},{"id":391024499,"identity":"dbb4a379-33b9-4263-add0-ef6f7e02e3b6","order_by":5,"name":"Qing Zhao","email":"","orcid":"","institution":"Yueyang Hospital of Integrated Traditional Chinese and Western Medicine","correspondingAuthor":false,"prefix":"","firstName":"Qing","middleName":"","lastName":"Zhao","suffix":""},{"id":391024500,"identity":"24b0ddb0-15bb-4e9c-b38c-3469de9e5043","order_by":6,"name":"Shuqiang Wang","email":"data:image/png;base64,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","orcid":"","institution":"Yueyang Hospital of Integrated Traditional Chinese and Western Medicine","correspondingAuthor":true,"prefix":"","firstName":"Shuqiang","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-09-27 01:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5161501/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5161501/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":74298958,"identity":"0ea43e08-0fc8-459c-95e2-70c11dd18cb8","added_by":"auto","created_at":"2025-01-20 19:31:30","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":328671,"visible":true,"origin":"","legend":"","description":"","filename":"scientificreportslatex.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5161501/v1_covered_adc58254-6cd8-4ec7-a712-e1403c1a69f5.pdf"},{"id":71998988,"identity":"3b47cc7b-fe97-474a-861a-2413d75b9493","added_by":"auto","created_at":"2024-12-20 13:00:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":120237,"visible":true,"origin":"","legend":"","description":"","filename":"supplementarymaterial.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5161501/v1/751faf495cad58a92ff4ba76.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAssociation of Life’s Essential 8 with femur osteoporosis among US adults: a cross-sectional study from NHANES\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"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":"Osteoporosis, Bone mineral density, Adults, Lifestyle factors, Life’s Essential 8","lastPublishedDoi":"10.21203/rs.3.rs-5161501/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5161501/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eOsteoporosis is a significant public health concern characterized by decreased bone mineral density and increased fracture risk, particularly among older adults. Lifestyle factors play a crucial role in bone health, and the American Heart Association’s Life’s Essential 8 score has been associated with various health outcomes. However, the relationship between LE8 scores and osteoporosis risk remains underexplored. We conducted a cross-sectional study among 6,748 participants aged 50 years and older from the National Health and Nutrition Examination Survey. Femur BMD was measured using dual-energy X-ray absorptiometry, and osteoporosis was defined according to the World Health Organization criteria. LE8 scores were calculated based on the American Heart Association’s guidelines, with scores categorized as low, moderate, or high. Multivariable logistic regression and modified Poisson regression with robust error variance were employed to assess the association between LE8 scores and osteoporosis risk. Higher LE8 scores were significantly associated with increased femur BMD and a reduced risk of osteoporosis. Compared to participants with low LE8 scores, those with moderate and high LE8 scores had significantly lower adjusted odds of osteoporosis (aOR: 0.62, 95% CI: 0.46-0.83; aOR: 0.53, 95% CI: 0.31-0.89, respectively). The adjusted relative risks (aRR) were also significantly lower for the moderate and high LE8 groups (aRR: 0.70, 95% CI: 0.56-0.86; aRR: 0.62, 95% CI: 0.42-0.92, respectively). A nonlinear relationship was observed between LE8 scores and BMD (P for nonlinearity \u0026lt; 0.001), indicating more substantial reductions in osteoporosis risk at higher LE8 scores. Subgroup analyses revealed that the protective effect of higher LE8 scores was more pronounced in non-hispanic whites and premenopausal women. These findings suggest LE8 scores are negatively and nonlinearly associated with osteoporosis risk among U.S. adults aged 50 and older.\u003c/p\u003e","manuscriptTitle":"Association of Life’s Essential 8 with femur osteoporosis among US adults: a cross-sectional study from NHANES","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-20 13:00:05","doi":"10.21203/rs.3.rs-5161501/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":"532c5882-a279-4ec9-aa2b-b6aafeb707ed","owner":[],"postedDate":"December 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":41882970,"name":"Health sciences/Medical research/Epidemiology"},{"id":41882971,"name":"Health sciences/Health care/Disease prevention/Lifestyle modification"}],"tags":[],"updatedAt":"2025-02-14T05:08:10+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-20 13:00:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5161501","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5161501","identity":"rs-5161501","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}