Article Title



Brian Ferguson, Patrick Wilson. Old Dominion University, Norfolk, VA.

BACKGROUND: Poor bone mineral density (BMD), an indicator of overall bone health, is common in the United States and can lead to negative health outcomes. Body mass index (BMI) and waist circumference (WC) are commonly utilized anthropometric measures to predict BMD at the population level. Trunk-to-leg-volume ratio is a more reliable predictor of diabetes and mortality risk than BMI or WC. The goal of this analysis was to determine if trunk-to-leg-volume is a more accurate predictor of BMD, osteopenia/osteoporosis risk, or fracture risk than BMI or WC. METHODS: A secondary analysis of publicly available NHANES data including the years 2013-2014 and 2017-2018 was conducted. Utilizing available Dual-Energy X-Ray Absorptiometry (DXA) data, linear and logistic regression models were constructed to assess the outcomes of BMD at the femoral neck and the lumbar spine, risk of osteopenia or osteoporosis at those sites, and fracture history at the hip, wrist, and spine. Trunk-to-leg volume ratio was calculated from available DXA data, and subgroups were created while considering control variables such as smoking, age, and physical activity. Unadjusted models were run and followed with constructed adjusted models that controlled for possible confounding variables. RESULTS: BMI, WC, and trunk-to-leg volume ratio were ineffective at predicting previous wrist, hip, or spine fractures. In select cases, such as the unadjusted female model predicting osteopenia/osteoporosis at the lumbar spine (n = 1,277), trunk-to-leg-volume ratio significantly correlated with osteopenia/osteoporosis; OR = 1.09 (95% CI: [1.02, 1.16]), p < .01. At the femoral neck, across all male (n = 942) and female (n = 975) models, BMI and WC positively correlate with BMD (p < .001) and a lower risk of osteopenia/osteoporosis. Trunk-to-leg-volume ratio does not consistently associate with BMD at the hip. CONCLUSIONS: BMI and WC have a protective effect with respect to BMD at the femoral neck while trunk-to-leg-volume ratio has a more neutral association. Trunk-to-leg-volume ratio offers promise in predicting osteopenia or osteoporosis in certain cases. Additionally, trunk-to-leg volume ratio appears to be at least as good as WC or BMI in predicting fracture history at the wrist, hip, or spine.

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