Exploring the association between Zhejiang University index and osteoporosis risk in middle-aged and older adults based on the National Health and Nutrition Examination Survey database
- 1Department of Orthopedics and Rheumatology, ,
- 2,
- 3Jiangsu CM Clinical Innovation Center of Degenerative Bone & Joint Disease, .
Abstract
Background Osteoporosis is a metabolic bone disease characterized by reduced bone density and an increased risk of fractures. Metabolic factors, including body mass index and blood glucose levels, are associated with osteoporosis. The Zhejiang University index, which integrates these factors, may influence the risk of osteoporosis. Using data from the National Health and Nutrition Examination Survey database, this study examined the association between the Zhejiang University index and osteoporosis risk, thereby providing a potential novel indicator and strategy for the early detection and intervention of osteoporosis. Methods Data from the National Health and Nutrition Examination Survey (2007–2008 and 2013–2014) were analyzed, resulting in a final cohort of 1003 participants after accounting for fasting subsample and dual-energy X-ray absorptiometry data constraints. Weighted multivariable logistic regression and restricted cubic splines analyses were used to evaluate the association between the Zhejiang University index and osteoporosis. Several sensitivity analyses were conducted, including redefining the outcome using only dual-energy X-ray absorptiometry–confirmed cases and recalculating the Zhejiang University index without its intrinsic sex adjustment (+2 points for female participants). Variable selection was performed using Least Absolute Shrinkage and Selection Operator regression, and model performance was evaluated using receiver operating characteristic curves. Results The Zhejiang University index was significantly inversely associated with the risk of osteoporosis. In the fully adjusted model, participants in the highest quartile had a significantly lower risk of osteoporosis than those in the lowest quartile (odds ratio = 0.18, 95% confidence interval: 0.11–0.31, p < 0.001). Conversely, when the highest quartile was used as the reference, individuals in the lowest quartile faced a 5.50-fold higher risk of osteoporosis (odds ratio = 5.50, 95% confidence interval: 3.21–9.43). Restricted cubic splines analysis confirmed a linear inverse relationship (p overall < 0.001, p nonlinear = 0.387). Sensitivity analyses demonstrated that the protective association was robust against diagnostic criteria and intrinsic sex weighting. The final 10-variable prediction model achieved an area under the curve of 0.763, demonstrating superior performance compared with models based solely on clinical factors. Conclusion The Zhejiang University index independently predicts the risk of osteoporosis, and the associated prediction model demonstrated good performance, providing a useful tool for clinical screening.
Related
- Association Between Aerobic Physical Activity and Hypertension Among U.S. Adults: A Cross-Sectional Analysis of NHANES (National Health and Nutrition Examination Survey) 2021-2023
- Association Between Sleep Duration and Obesity Phenotypes in Apparently Healthy Korean Adults: A Cross-Sectional Study Using the Korea National Health and Nutrition Examination Survey 2013–2015
- Association of breakfast skipping with diet-quality-based low-carbohydrate and low-fat diet scores and metabolic syndrome components among Korean young adults: Korea National Health and Nutrition Examination Survey 2021–2023
- Association between smoking status and choroidal thickness in the Korean population: Korea National Health and Nutrition Examination Survey 2017–2021
- Joint Association of Sedentary Time and Physical Activity with Metabolic Syndrome Among Korean Adults: A Cross-Sectional Analysis of the 2024 Korea National Health and Nutrition Examination Survey.
BibTeX
@article{gu2026exploring,
title = {{Exploring the association between Zhejiang University index and osteoporosis risk in middle-aged and older adults based on the National Health and Nutrition Examination Survey database}},
author = {Rui Gu and Jian Zhang and Yanhao Ge and Zhuoyi Hu and Yafeng Zhang},
journal = {Journal of International Medical Research},
year = {2026},
month = oct,
doi = {10.1177/03000605261477328},
url = {https://doi.org/10.1177/03000605261477328},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Exploring the association between Zhejiang University index and osteoporosis risk in middle-aged and older adults based on the National Health and Nutrition Examination Survey database
AU - Rui Gu
AU - Jian Zhang
AU - Yanhao Ge
AU - Zhuoyi Hu
AU - Yafeng Zhang
PY - 2026
DA - 2026/10/30
JO - Journal of International Medical Research
DO - 10.1177/03000605261477328
UR - https://doi.org/10.1177/03000605261477328
AB - Background Osteoporosis is a metabolic bone disease characterized by reduced bone density and an increased risk of fractures. Metabolic factors, including body mass index and blood glucose levels, are associated with osteoporosis. The Zhejiang University index, which integrates these factors, may influence the risk of osteoporosis. Using data from the National Health and Nutrition Examination Survey database, this study examined the association between the Zhejiang University index and osteoporosis risk, thereby providing a potential novel indicator and strategy for the early detection and intervention of osteoporosis. Methods Data from the National Health and Nutrition Examination Survey (2007–2008 and 2013–2014) were analyzed, resulting in a final cohort of 1003 participants after accounting for fasting subsample and dual-energy X-ray absorptiometry data constraints. Weighted multivariable logistic regression and restricted cubic splines analyses were used to evaluate the association between the Zhejiang University index and osteoporosis. Several sensitivity analyses were conducted, including redefining the outcome using only dual-energy X-ray absorptiometry–confirmed cases and recalculating the Zhejiang University index without its intrinsic sex adjustment (+2 points for female participants). Variable selection was performed using Least Absolute Shrinkage and Selection Operator regression, and model performance was evaluated using receiver operating characteristic curves. Results The Zhejiang University index was significantly inversely associated with the risk of osteoporosis. In the fully adjusted model, participants in the highest quartile had a significantly lower risk of osteoporosis than those in the lowest quartile (odds ratio = 0.18, 95% confidence interval: 0.11–0.31, p < 0.001). Conversely, when the highest quartile was used as the reference, individuals in the lowest quartile faced a 5.50-fold higher risk of osteoporosis (odds ratio = 5.50, 95% confidence interval: 3.21–9.43). Restricted cubic splines analysis confirmed a linear inverse relationship (p overall < 0.001, p nonlinear = 0.387). Sensitivity analyses demonstrated that the protective association was robust against diagnostic criteria and intrinsic sex weighting. The final 10-variable prediction model achieved an area under the curve of 0.763, demonstrating superior performance compared with models based solely on clinical factors. Conclusion The Zhejiang University index independently predicts the risk of osteoporosis, and the associated prediction model demonstrated good performance, providing a useful tool for clinical screening.
SN - 1473-2300
SN - 0300-0605
ER -