Body roundness index and its association with QUS-defined osteoporosis and bone mineral density in middle-aged and older adults: a cross-sectional analysis
Aug 2026· Frontiers in Endocrinology· Vol 17· 0 citations· 34 references
Medicine
TL;DR
Higher BRI was associated with QUS-defined osteoporosis, but BRI alone showed limited discrimination, and the fully adjusted model remained only moderately discriminative, which should be considered an adjunctive anthropometric indicator within a broader assessment framework.
Abstract
Objectives This study evaluated the association between Body Roundness Index (BRI) and QUS-defined osteoporosis, its discriminative ability, empirical cutoff, and subgroup heterogeneity in middle-aged and older adults. Methods We analyzed cross-sectional data from 1,444 community-dwelling adults aged 35–75 years. Osteoporosis was defined using tibial quantitative ultrasound-derived T-scores. Receiver operating characteristic curves assessed discrimination, restricted cubic splines examined dose-response relationships, logistic and robust regression analyses quantified associations, and subgroup analyses evaluated effect modification. Results The Youden index identified an optimal BRI cutoff of 4.5. High BRI (≥ 4.5) was associated with higher odds of osteoporosis in the unadjusted model (OR = 1.606, 95% CI: 1.292–1.996; P < 0.001), the age- and sex-adjusted model (OR = 1.432, 95% CI: 1.141–1.797; P = 0.002), and the fully adjusted model excluding BMI (OR = 1.404, 95% CI: 1.105–1.783; P = 0.005). The association was approximately linear (P for non-linearity = 0.539; P-overall < 0.001). BRI alone showed modest discrimination (AUC = 0.562, 95% CI: 0.529–0.594), which increased after adjustment for age and sex (AUC = 0.680, 95% CI: 0.652–0.710) and after full covariate adjustment (AUC = 0.695, 95% CI: 0.674–0.731). The association was stronger among participants with metabolic syndrome (OR = 2.62, 95% CI: 1.641–4.179) than among those without it (OR = 1.39, 95% CI: 1.040–1.860; P for interaction = 0.022). Conclusions Higher BRI was associated with QUS-defined osteoporosis, but BRI alone showed limited discrimination, and the fully adjusted model remained only moderately discriminative. BRI should therefore be considered an adjunctive anthropometric indicator within a broader assessment framework, rather than a stand-alone predictor or screening tool. Clinical trial registration https://www.chictr.org.cn/showproj.html?proj=187762, identifier ChiCTR2300071492.
Skeletal fragility in type 2 diabetes mellitus (T2DM) is incompletely represented by areal bone mineral density (BMD). We defined an operational reduced-BMD subgroup using routine hospital information-system data and examined whether routinely available clinical variables showed incremental associations and whether complex classifiers improved internal discrimination beyond age and sex. This single-center retrospective cross-sectional analysis included 329 de-identified analytical records from adults with T2DM who underwent routine dual-energy X-ray absorptiometry. The operational reduced-BMD subgroup was defined by the lowest T-score among the lumbar spine L1-L4, femoral neck, and total hip: records with at least one site-specific T-score ≤ − 1.0 were classified into the subgroup, and a stricter < -1.0 definition was examined as a boundary sensitivity analysis. Because menopausal status and Z-scores were unavailable, this rule was treated as an operational subgroup definition rather than a universal clinical diagnosis. Descriptive analyses, deliberately parsimonious Jeffreys-prior bias-reduced logistic models, fixed-unit age sensitivity analyses, and repeated nested internal classification were performed. Twenty-six records (7.9%) met the primary operational definition and 22 met the stricter definition; no record met a T-score ≤ − 2.5 threshold at the retained primary sites. Twenty-five of the 26 records in the reduced-BMD subgroup were from women. In the prespecified full-cohort model, age had an odds ratio (OR) of 5.39 per within-sample standard deviation (95% profile-likelihood confidence interval [CI], 2.71–12.15), and the female-sex estimate was large but imprecise (OR, 34.47; 95% CI, 8.29-321.11). On a common five-year scale, the age OR was 2.33 (95% CI, 1.65–3.50) in the full cohort and 2.29 (95% CI, 1.60–3.47) among records aged ≥ 50 years. The fixed age-sex classifier had a median internally validated ROC AUC of 0.921 (range, 0.915–0.923), decreasing to 0.901 (range, 0.897–0.904) in the age ≥ 50 subset. Among the tested algorithms and prespecified features, no complex classifier materially exceeded the fixed age-sex benchmark. In this selected single-center record-level dataset, the operational reduced-BMD subgroup was characterized principally by older age and marked female predominance. Restriction to age ≥ 50 years reduced apparent discrimination because of narrower case mix, while the age association remained similar on a fixed five-year scale. The additional tested variables did not provide precisely estimated incremental associations in the prespecified age-sex-plus-one-variable models, and the tested complex classifiers did not materially improve internal discrimination over the age-sex benchmark. All classification estimates were internally validated only, and the findings do not support causal, diagnostic, prognostic, deployment, or treatment claims. The operational reduced-BMD subgroup comprised 26 of 329 analytical records from adults with T2DM. Twenty-five of the 26 reduced-BMD records were from women, and all occurred at age ≥50 years. Jeffreys-prior bias-reduced logistic regression addressed sparse outcomes and near-separation. The age association was similar in the full cohort and the age ≥50 subset when expressed per five years. Within internal validation, the tested complex classifiers did not materially outperform the age-sex benchmark.
Song Lu, Bo Wan, Chun-Sheng Qian et al.· BMC Musculoskeletal Disorder...· 0 citations
This study aimed to evaluate the modifying effects and joint associations of handgrip strength (HGS) and bone mineral density (BMD) with all-cause mortality, with an exploratory analysis of cardiovascular disease (CVD) mortality. A primary analysis cohort ( n = 11150) and a replication cohort ( n = 5952) were included. Cox proportional hazards regression, restricted cubic spline analysis, and interaction analysis were used to examine the associations of BMD with mortality across relative HGS groups. Relative HGS was defined as absolute HGS divided by body weight. The joint effects of BMD-HGS combinations were assessed. During a median follow-up of 9.75 and 6.59 years, the primary analysis and replication cohorts recorded 1345 and 352 all-cause deaths, respectively. In the primary analysis cohort, low BMD was associated with an increased all-cause mortality risk in both the low and high relative HGS groups (hazard ratio [HR] = 1.26, 95% confidence interval [CI]: 1.04-1.52 and HR = 1.42, 95% CI: 1.16-1.74, respectively), with consistent findings in the replication cohort. No significant interaction was found between relative HGS and BMD ( P > 0.05). Participants with low BMD and low relative HGS had a 59%-62% higher risk of all-cause mortality than those with high BMD and high relative HGS in both cohorts, and the estimated PAR% for this combined exposure was 10.8%-13.1%. Results for CVD mortality were inconsistent across cohorts. In conclusion, low BMD with low handgrip strength is consistently associated with increased all-cause mortality, suggesting combined screening may benefit high-risk individuals.
Xin-Yi Huang, Ning-Li Han, Kai Ling et al.· Journal of Biomedical Resear...· 0 citations
Background/Objectives: Osteoporotic vertebral fractures (OVFs) can cause persistent pain and loss of independence. This study quantified impairment in basic and instrumental activities of daily living and identified independent cross-sectional correlates in postmenopausal women with OVFs. Methods: This cross-sectional analysis included 184 postmenopausal women from a 200-patient OVF cohort at a spine clinic in Vietnam. Functional status was assessed using the Barthel Index (BI) and Lawton Instrumental Activities of Daily Living (IADL) scale. Primary analyses used multivariable linear regression with HC3 robust inference; ordered-logistic and model-specification analyses assessed robustness. Results: Mean age was 69.95 ± 7.78 years and mean visual analog scale (VAS) pain score was 6.69 ± 1.58. Basic-activity dependence was present in 81.5% of participants (mean BI, 82.96 ± 16.45), and 66.8% had at least one IADL limitation (mean IADL, 5.84 ± 2.04). In the adjusted BI model, higher VAS pain intensity was the strongest observed correlate of poorer function (B = −7.996; β = −0.769; p < 0.001), and higher body mass index was associated with lower BI. In the adjusted IADL model, higher VAS pain intensity (B = −0.694; β = −0.538; p < 0.001) and older age were associated with lower scores. Ordinal sensitivity analyses confirmed the pain association, whereas the BMI finding was attenuated. Conclusions: Pain intensity was the strongest observed cross-sectional correlate of both functional domains. The findings support comprehensive functional assessment and hypothesis-driven longitudinal studies, but they do not establish that pain reduction will cause functional recovery.
Ngoc Quyen Nguyen, Hong Van Vu, Viet Ha Pham et al.· Biomedicines· 0 citations
FRAX-derived fracture probability in postmenopausal women is associated not only with bone-related parameters but also with muscle structure, muscle quality, and physical performance, which highlights the potential relevance of muscle-related parameters within the broader musculoskeletal profile reflected by FRAX.
I. Özbek, İpek Okutan· Egyptian Rheumatology and Re...· 0 citations
OBJECTIVE
To gain insight into higher fracture risk in individuals with type 2 diabetes, we determined the association of type 2 diabetes glycemic status and severity with longitudinal changes in peripheral bone density and microarchitecture.
RESEARCH DESIGN AND METHODS
We conducted a longitudinal study of 769 participants from the Framingham Study who underwent high-resolution, peripheral, quantitative computed tomography (HR-pQCT) at the tibia and radius, in 2012-2016 and 2021-2023 (mean 8-year follow-up). Linear regression models estimated mean 8-year percent changes in bone measures, across indicators of diabetes severity, adjusting for age, sex, weight, and height.
RESULTS
The mean age was 67 ± 7 years, and 59% of participants were women. More than half (57%) were normoglycemic (fasting plasma glucose [FPG] <100 mg/dL, not on any treatment), 31% had prediabetes (100 ≤ FPG ≤125 mg/dL), and 12% had type 2 diabetes (FPG >125 mg/dL or on treatment). Adjusted mean percent changes in HR-pQCT bone measures were similar across diabetes severity, including glycemic status, use of diabetes medications, duration of diabetes, and HbA1c. For example, cortical volumetric bone mineral density at the radius changed by -1.50% (95% CI -2.43, -0.56) in type 2 diabetes and -1.96% (-2.53, -1.39), in prediabetes, compared with -2.42% (-2.86, -1.97) in normoglycemia (reference group; all P > 0.05).
CONCLUSIONS
The magnitude of peripheral bone loss over 8 years did not differ between individuals with type 2 diabetes and those with normoglycemia, suggesting that bone deterioration alone does not explain the higher fracture risk in older adults with type 2 diabetes. Future studies should address other contributors to skeletal fragility.
A. Dufour, M. Bouxsein, Mu-Song Gao et al.· Diabetes Care· 0 citations
It is indicated that trabecular microarchitecture deteriorates earlier and more rapidly with aging than bone mass loss captured by BMD, supporting the use of TBS as a complementary tool for evaluating skeletal health and fracture risk.
Caroline de Freitas Gomes, R. M. Pereira, J. Alvarenga et al.· Menopause· 0 citations
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