Evaluating the role of biological age in osteoporosis risk among middle-aged and older adults: A nationwide perspective

Abstract

Objectives

This study aimed to investigate the association between biological age acceleration and osteoporosis (OP) risk in middle-aged and older adults using data from the National Health and Nutrition Examination Survey (NHANES). The research focused on analyzing the relationship between two biological aging metrics, Klemera-Doubal Method Age (KDMAge) and Phenotypic Age (PhenoAge), and OP risk.

Methods

The study analyzed data from NHANES, which included 6550 participants aged 50 and above from survey cycles 2005–2010 and 2017–2018. Linear and logistic regression were used to investigate the relationship between biological age acceleration (KDMAgeAccel and PhenoAgeAccel) and OP. Subgroup analysis was performed by age, gender and other factors. Multivariable Cox regression analysis yielded Hazard Ratios (HRs) relating biological age acceleration to mortality were evaluated. The study also considered the mediating roles of body mass index (BMI).

Results

KDMAgeAccel (odds ratio [OR] = 2.34, 95 % CI, 1.72–3.18) and PhenoAgeAccel (OR = 2.03, 95 % CI, 1.48–2.78) were significantly associated with increased OP risk and reduced bone mineral density (BMD). Specifically, higher KDMAgeAccel and PhenoAgeAccel were linked to higher OP prevalence and lower BMD at multiple sites. Subgroup analyses indicated that the association between accelerated biological age acceleration and OP risk was consistent across different demographics. Mediation analysis revealed that BMI partially mediated the relationship between accelerated biological age and OP, although other mechanisms are likely involved. Statistical analysis indicated that individuals with higher biological age metrics had increased mortality risk related to OP.

Conclusion

The findings suggest that accelerated biological age is a robust predictor of OP risk and related mortality. KDMAgeAccel and PhenoAgeAccel could serve as valuable biomarkers for identifying individuals at high risk for OP, guiding preventive strategies.