Muscle Mass, Adiposity, and Bone Health in Surgical Care Setting: A Cross-Sectional Study

Background: Osteoporosis and sarcopenia are interrelated conditions that significantly affect surgical outcomes by impairing bone strength, mobility, and postoperative recovery. Understanding how body composition and metabolic factors influence bone mineral density (BMD) is essential for improving perioperative risk assessment and rehabilitation. This study aimed to evaluate the relationships between regional muscle mass, fat mass (FM), and circulating adipokines with BMD.Methods: A cross-sectional study was conducted in 199 patients. Whole-body dual energy X-ray absorptiometry (DXA) was used to assess regional lean and FM and BMD at multiple skeletal sites. Serum leptin and adiponectin were measured by enzyme-linked immunosorbent assay. Correlations were examined using Pearson’s coefficients, and stepwise multiple linear regression identified independent predictors of T-score.Results: Trunk and gynoid muscle mass exhibited the strongest positive correlations with T-score (r=0.490 and r=0.475, both P<0.001). FM showed weaker associations, while adiponectin correlated inversely with BMD (r=-0.196, P=0.005). In multivariable analysis, trunk muscle mass (β=0.48, P<0.001), gynoid muscle mass (β=0.36, P=0.002), body mass index (β=0.18, P=0.031), and adiponectin (β=-0.22, P=0.008) remained independent predictors (adjusted R²=0.45).Conclusions: Skeletal muscle, particularly in the trunk and hip regions, is the primary determinant of bone density, while adiponectin negatively influences BMD. Incorporating muscle mass assessment and metabolic optimization into perioperative care may enhance fixation stability and postoperative recovery.