Abstract
BACKGROUND: Bone tumors are rare but highly aggressive malignancies associated with considerable mortality. Emerging evidence identifies obesity as a contributor to multiple malignancies, including those of osseous origin, primarily through mechanisms involving endocrine imbalance and chronic inflammation. Conventional obesity metrics, like body mass index (BMI), cannot reflect the full spectrum of obesity-related risks. In contrast, the age-adjusted visceral adiposity index (AVAI) offers a more holistic evaluation of obesity-associated hazards. METHODS: This cross-sectional analysis utilized National Health and Nutrition Examination Survey (NHANES) data collected between 2011 and 2018. After excluding participants younger than 18 years and those lacking complete information on bone tumors or AVAI, the final analytic cohort comprised 3,731 adults. The AVAI was calculated using BMI, waist circumference, age, high-density lipoprotein levels, and triglyceride levels. The presence of a bone tumor was ascertained through medical questionnaires. Logistic regression analyses were applied to evaluate the association between AVAI levels and the occurrence of bone neoplasms, after adjusting for potential confounders such as hypertension, diabetes, and other metabolic variables. RESULTS: The prevalence of bone tumors increased with higher AVAI quartiles, reaching 4.07 % in the highest quartile (Q4). Univariate logistic regression demonstrated a significant positive association between AVAI and bone tumors (OR = 1.19, 95 % CI: 1.02-1.31, P < 0.0001). After accounting for all demographic, metabolic, and clinical covariates, higher AVAI quartiles remained strongly associated with elevated bone tumor risk, with adjusted odds ratios of 1.64 (Q2), 2.15 (Q3), and 2.81 (Q4) compared to the reference quartile (Q1). CONCLUSION: The findings indicate a significant association between AVAI and the likelihood of bone tumor development, thus emphasizing the necessity of incorporating visceral adiposity into the assessment of skeletal neoplasm incidence. Future studies should focus on the underlying mechanisms and investigate potential interventions targeting obesity-related factors to mitigate the risk of bone tumors.