ORIGINAL RESEARCH article
Front. Med.
Sec. Geriatric Medicine
Association between novel inflammatory indices and osteoporosis among older adults: Evidence from a large multicenter study in China
Ling Zeng 1
Hongyan Zhang 2
Meng Wang 3
Yu Zhang 4
Xiaoyu Zhang 5
Keli Li 6
Xiu Sun 7
Xi Chen 1
1. Department of Traditional Chinese Medicine, Integrated Chinese and Western Medicine Diagnosis and Treatment Center, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
2. Heart, Lung and Vessels Center, Sichuan Provincial People’s Hospita, cheng du, China
3. Pain Diagnosis and Treatment Center, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
4. Pain Diagnosis and Treatment Center, People’s Hospital of Xinjiang Uygur Autonomous Region, urumqi, China
5. Xinjiang Medical University, Urumqi, China
6. Department of General Medicine, Huangshan City People’s Hospital, huangshan, China
7. Department of Endocrinology, Chengdu First People’s Hospital, chengdu, China
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Abstract
Objectives: Chronic systemic inflammation is increasingly recognized as a key contributor to the development of osteoporosis.This investigation seeks to assess how effectively several inflammation‑derived composite indices can diagnose osteoporosis in the elderly population. Methods: A multicenter cross-sectional study was conducted across four hospitals in China from January 2023 to May 2025, enrolling 3,625 participants aged ≥60 years. Associations between inflammatory markers and osteoporosis were examined with multivariable logistic regression, and potential nonlinear patterns were further investigated using restricted cubic spline (RCS) models. Diagnostic accuracy was assessed through receiver operating characteristic (ROC) curves and decision curve analysis (DCA). Results: Elevated values of several inflammation-related indices were associated with a higher likelihood of osteoporosis in multivariable analyses. RCS analysis demonstrated a nonlinear dose-response pattern (P for nonlinearity < 0.001). These findings were consistent across stratified and sensitivity analyses. Among all indices evaluated, the Aggregate Index of Systemic Inflammation (AISI) exhibited the strongest association with osteoporosis (OR = 1.63;95%CI: 1.49 - 1.78). Conclusions: This multicenter study demonstrates that elevated inflammatory indices are independently associated with osteoporosis, with AISI emerged as the superior marker, offering a novel, cost-effective tool for early identification of osteoporosis in clinical practice.
Summary
Keywords
Inflammatory indices, Multicentre study, older adults, Osteoporosis, systemic inflammation
Received
23 December 2025
Accepted
20 February 2026
Copyright
© 2026 Zeng, Zhang, Wang, Zhang, Zhang, Li, Sun and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Xi Chen
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