Impact of Social Determinants of Health on Osteoporosis Risk: A Cross-Sectional Analysis of NHANES Data

Background: Osteoporosis is a significant health issue, especially among older adults, leading to increased fracture risk and diminished quality of life. Social determinants of health (SDoH) have been shown to influence various health outcomes. However, the relationship between SDoH and osteoporosis remains underexplored.Methods: We conducted a cross-sectional analysis using National Health and Nutrition Examination Survey (NHANES) data from 2005-2010, 2013-2014, and 2017-2018, including 9,484 participants aged 50 and older. SDoH was assessed through components including employment status, poverty income ratio, food security, education level, access to healthcare, health insurance, home ownership, and marital status. SDoH scores ranged from 0 to 8, with higher scores indicating worse social conditions. Osteoporosis was defined based on bone mineral density (BMD) measurements of the femoral neck and total femur, with a T-score ≤ -2.5 indicating osteoporosis. Logistic and linear regression models were used to assess the association between SDoH scores and osteoporosis. Subgroup and sensitivity analyses were performed to test the robustness of the results. Receiver Operating Characteristic (ROC) analysis was used to assess the predictive value of SDoH for osteoporosis.Results: In the fully adjusted model, participants in the medium (3-5) and high (6-8) SDoH score groups had 1.76 (95% CI: 1.36–2.29; P