Abstract
BACKGROUND: Metabolic Score for Visceral Fat (METS-VF) is commonly used as an indicator for assessing visceral fat metabolism. However, the relationship between METS-VF, Bone Mineral Density (BMD), and osteoporosis remains unclear in the American population. METHODS: This study utilized cross-sectional data from the National Health and Nutrition Examination Survey (NHANES), including participants aged 20 years and older, from the survey cycles conducted between 2005 and 2010, 2013-2014, and 2017-2018. Multivariable weighted linear regression and logistic regression analyses were first applied to investigate the associations between the METS-VF, femoral BMD, and osteoporosis. In addition, subgroup interaction analyses were performed to evaluate the robustness of these associations. To address potential non-linear relationships, restricted cubic spline regression was employed. All statistical analyses were conducted using R software version 4.3.3. P values were two-tailed, with P < 0.05 considered statistically significant. RESULTS: After adjusting for all covariates, the positive correlations between METS-VF and BMD measurements at all sites remained statistically significant (p < 0.001 & p for trend < 0.001). Multivariable logistic regression analysis indicated that, after adjusting for covariates related to osteoporosis, each one-unit increase in METS-VF was associated with a 63.1% reduction in the risk of developing osteoporosis. Moreover, the direction of the associations between METS-VF and both BMD and osteoporosis remained consistent across all subgroups, while restricted cubic spline (RCS) analyses suggested nonlinear relationships. The 5.82-7.35 METS-VF range yielded a mean 51.9% osteoporosis risk reduction (sustained ≥ 30% peak efficacy in 66.7% of participants). CONCLUSIONS: METS-VF demonstrated a nonlinear positive association with BMD and a nonlinear inverse relationship with osteoporosis risk. Future studies should establish optimal biological thresholds of METS-VF for skeletal health. CLINICAL TRIAL NUMBER: Not applicable.