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

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 &lt; 0.001) and 3.12 (95% CI: 1.88–5.18; P &lt; 0.001) times higher odds of osteoporosis, respectively, compared to the low (0-2) score group. All SDoH components, except access to healthcare, were significantly associated with osteoporosis. These findings remained consistent in subgroup and sensitivity analyses. ROC analysis showed that SDoH components, along with sex, age, race/ethnicity, and body mass index, effectively predicted osteoporosis (Sensitivity: 0.750, Specificity: 0.772, AUC: 0.839 [95% CI: 0.823–0.854], P &lt; 0.001).Conclusion: Higher SDoH scores are associated with an increased risk of osteoporosis. Addressing social disparities, such as improving food security and reducing poverty, could help mitigate osteoporosis risk. SDoH and easily accessible demographic data can effectively predict osteoporosis risk, offering potential for early identification and intervention.