Sex-stratified associations between movement behaviors and QUS-defined osteoporosis in rural adults: an isotemporal substitution analysis

@article{jin2026sexstratified,
  title = {{Sex-stratified associations between movement behaviors and QUS-defined osteoporosis in rural adults: an isotemporal substitution analysis}},
  author = {Haidong Jin and Xueru Shi and Hongfei Zhao and Chengrui Zhang and Chongjian Wang and Fengling Wang and Jun Pan},
  journal = {BMC Public Health},
  year = {2026},
  month = oct,
  doi = {10.1186/s12889-026-29599-w},
  url = {https://link.springer.com/article/10.1186/s12889-026-29599-w},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Sex-stratified associations between movement behaviors and QUS-defined osteoporosis in rural adults: an isotemporal substitution analysis
AU  - Haidong Jin
AU  - Xueru Shi
AU  - Hongfei Zhao
AU  - Chengrui Zhang
AU  - Chongjian Wang
AU  - Fengling Wang
AU  - Jun Pan
PY  - 2026
DA  - 2026/10/22
JO  - BMC Public Health
DO  - 10.1186/s12889-026-29599-w
UR  - https://link.springer.com/article/10.1186/s12889-026-29599-w
AB  - Background: Previous studies have explored the independent effects of different movement behaviors on osteoporosis (OP), but limited research on their substitution effects, especially among rural adults in resource-limited areas. This study investigates the associations between hypothetical time reallocations among different movement behaviors and QUS-defined osteoporosis.  Methods: This cross-sectional study included 7368 participants selected from the second wave survey of the Henan Rural Cohort Study. Osteoporosis was defined using calcaneal quantitative ultrasound (QUS), and participants with a QUS T-score ≤ − 2.5 were classified as having QUS-defined osteoporosis. Logistic regression and restricted cubic spline were applied to examine the relationships between movement behaviors and QUS-defined osteoporosis. The isotemporal substitution model was employed to evaluate associations under hypothetical time reallocations among behaviors.  Results: Long nocturnal sleep duration was associated with higher odds of QUS-defined osteoporosis in both sexes, while daytime napping was associated with higher odds in women. Sedentary behavior was associated with higher odds in men ( OR : 1.58, 95% CI : 1.05–2.37), whereas walking was associated with lower odds in both sexes (all P < 0.05). Isotemporal substitution analysis showed that reallocating 30–60 min from nocturnal sleep, sedentary behavior, or moderate-to-vigorous physical activity (MVPA) to walking was associated with lower odds of QUS-defined osteoporosis in both sexes (all P < 0.05). In women, reallocating 30 min of daytime napping to walking was also associated with lower odds of QUS-defined osteoporosis ( OR : 0.90, 95% CI : 0.85–0.95). In addition, reallocating 30 min of nocturnal sleep to MVPA was associated with lower odds of QUS-defined osteoporosis in women ( OR : 0.97, 95% CI : 0.94–0.99).  Conclusion: In this cross-sectional study, hypothetical reallocation of 30–60 min from nocturnal sleep, sedentary behavior, or MVPA to walking was associated with lower odds of QUS-defined osteoporosis. In women, reallocating the same duration from nocturnal time to MVPA was also associated with lower odds.  Clinical trial registration: The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 2015-07-06. http://www.chictr.org.cn/showproj.aspx?proj=11375 .
SN  - 1471-2458
ER  -