Abstract
BACKGROUND: Insulin resistance (IR) is implicated in bone metabolism dysregulation, but the role of Triglyceride Glucose Body Mass Index (TyG-BMI), a surrogate marker integrating lipid-glucose metabolism and adiposity, in osteoporosis risk remains underexplored. METHODS: We analyzed 23,930 participants categorized into TyG-BMI quartiles (Q1-Q4). Baseline characteristics, biochemical profiles, and medication use were compared. Osteoporosis incidence was tracked over a 4-year median follow-up. Cox models estimated hazard ratios (HRs) for osteoporosis across quartiles of TyG-BMI, adjusted for confounders. Stratified analyses were performed to explore the effect modification by age, sex, renal function, smoking, and medication use. RESULTS: Osteoporosis incidence (1,134 cases) rose sharply from Q1 (71 cases) to Q4 (855 cases).Participants in Q4 (highest TyG-BMI) were younger (mean age 56.2 vs. Q1: 63.0 years) with higher BMI (29.7 vs. 20.8 kg/m²), fasting glucose (9.15 vs. 7.02 mmol/L), triglycerides (2.95 vs. 1.06 mmol/L). Osteoporosis incidence rose sharply from Q1 (71 cases) to Q4 (855 cases). In fully-adjusted models, Q4 had a 3.67-fold higher osteoporosis risk vs. Q1 (95% CI: 2.80-4.80; P < 0.001). Stratified analyses revealed stronger associations in participants aged <65 years (HR: 14.6; 95% CI: 10.4-20.6), males (HR: 12.4; 95% CI: 8.79-17.6), smokers (HR: 15.2; 95% CI: 6.77-34.0), and those with preserved renal function (HR: 12.2; 95% CI: 8.99-16.7). CONCLUSION: Elevated TyG-BMI independently predicts incident osteoporosis, with the highest risk in younger males, smokers, and individuals with preserved renal function. TyG-BMI may serve as a practical tool for early osteoporosis risk stratification.