Association of Life’s Essential 8 with femur osteoporosis among US adults: a cross-sectional study from NHANES

Osteoporosis is a significant public health concern characterized by decreased bone mineral density and increased fracture risk, particularly among older adults. Lifestyle factors play a crucial role in bone health, and the American Heart Association’s Life’s Essential 8 score has been associated with various health outcomes. However, the relationship between LE8 scores and osteoporosis risk remains underexplored. We conducted a cross-sectional study among 6,748 participants aged 50 years and older from the National Health and Nutrition Examination Survey. Femur BMD was measured using dual-energy X-ray absorptiometry, and osteoporosis was defined according to the World Health Organization criteria. LE8 scores were calculated based on the American Heart Association’s guidelines, with scores categorized as low, moderate, or high. Multivariable logistic regression and modified Poisson regression with robust error variance were employed to assess the association between LE8 scores and osteoporosis risk. Higher LE8 scores were significantly associated with increased femur BMD and a reduced risk of osteoporosis. Compared to participants with low LE8 scores, those with moderate and high LE8 scores had significantly lower adjusted odds of osteoporosis (aOR: 0.62, 95% CI: 0.46-0.83; aOR: 0.53, 95% CI: 0.31-0.89, respectively). The adjusted relative risks (aRR) were also significantly lower for the moderate and high LE8 groups (aRR: 0.70, 95% CI: 0.56-0.86; aRR: 0.62, 95% CI: 0.42-0.92, respectively). A nonlinear relationship was observed between LE8 scores and BMD (P for nonlinearity < 0.001), indicating more substantial reductions in osteoporosis risk at higher LE8 scores. Subgroup analyses revealed that the protective effect of higher LE8 scores was more pronounced in non-hispanic whites and premenopausal women. These findings suggest LE8 scores are negatively and nonlinearly associated with osteoporosis risk among U.S. adults aged 50 and older.