Uric acid to high-density lipoprotein cholesterol ratio and osteoporosis: evidence from the National Health and Nutrition Examination Survey

Abstract Background: Uric acid to high-density lipoprotein cholesterol ratio (UHR) was a novel indicator reflecting inflammatory and metabolic status. This study aimed to investigate the association between UHR and bone mineral density (BMD), as well as the risk of osteoporosis, in individuals aged 50 years and above. Methods: This cross-sectional study included participants aged 50 and older from the National Health and Nutrition Examination Survey. Dual-energy X-ray absorptiometry (DXA) was employed to measure femoral neck BMD (FN-BMD). Furthermore, linear regression models were employed to examine the association between UHR and FN-BMD, while generalized additive models were used to assess the nonlinear relationship between UHR and FN-BMD. In addition, logistic regression models were employed to evaluate the association between UHR and the risk of osteoporosis. Results: Finally, 2,963 adults were included in this study, with a mean age of 64.16 ± 8.92 years. The results of linear regression models revealed a positive association between UHR and FN-BMD with or without adjustment for covariates. Furthermore, the results of logistic regression models suggested that elevated UHR levels were associated with a decreased risk of osteoporosis with or without adjustment for covariates. Moreover, the results of subgroup analysis showed that the positive association between UHR and BMD was observed among individuals aged 65 and older but not those aged 50 to 64 after stratification by age, and interaction analyses for age showed significant differences after adjustment for all covariates. Conclusions: Clinicians should be alert to the potential risk of osteoporosis among individuals with low UHR levels. UHR might serve as a risk indicator for osteoporosis.