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.
Liu et al. (Tue,) studied this question.