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Introduction <p>This study aimed to systematically evaluate the association between the Healthy Eating Index (HEI-2020), the Alternative Healthy Eating Index (AHEI), and the risk of osteoporotic fractures based on the National Health and Nutrition Examination Survey (NHANES) database.</p> Materials and methods <p>We included 13,541 participants from NHANES data, of whom 1,646 experienced osteoporotic fractures. Diet quality was assessed using HEI-2020 and AHEI scores. Weighted multivariable logistic regression, restricted cubic spline (RCS) analysis, and subgroup analyses were applied to evaluate the relationship between HEI-2020, AHEI, and osteoporotic fracture risk.</p> Results <p>After full adjustment for confounding factors, each 1-point increase in HEI-2020 and AHEI scores was associated with a 1.5% (OR = 0.985, 95% CI: 0.978–0.992) and 1.3% (OR = 0.987, 95% CI: 0.980–0.994) reduction in osteoporotic fracture risk, respectively. RCS analysis indicated that both HEI-2020 (p for nonlinear = 0.2911) and AHEI (p for nonlinear = 0.3951) were linearly and inversely associated with osteoporotic fracture risk (all <i>P</i> overall &lt; 0.0001). Subgroup analyses showed that this association remained consistent across populations stratified by sex, age, BMI, smoking status, hypertension, diabetes, and cardiovascular disease, with no significant interactions observed. Sensitivity analyses excluding participants who reported the use of prescription medications for hypertension or diabetes yielded results consistent with the primary analyses after multivariable adjustment.</p> Conclusion <p>This study systematically showed a significant inverse association between HEI-2020, AHEI, and osteoporotic fracture risk. The findings suggest that improving diet quality may be a feasible strategy for preventing osteoporotic fractures, with broad population applicability and public health implications.</p>

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Inverse association between diet quality and the risk of osteoporotic fractures: a cross-sectional analysis

  • 期刊论文

  • 发表日期：

    2026年3月12日

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  • Xi Liu,
  • Bin Xu

摘要

Introduction

This study aimed to systematically evaluate the association between the Healthy Eating Index (HEI-2020), the Alternative Healthy Eating Index (AHEI), and the risk of osteoporotic fractures based on the National Health and Nutrition Examination Survey (NHANES) database.

Materials and methods

We included 13,541 participants from NHANES data, of whom 1,646 experienced osteoporotic fractures. Diet quality was assessed using HEI-2020 and AHEI scores. Weighted multivariable logistic regression, restricted cubic spline (RCS) analysis, and subgroup analyses were applied to evaluate the relationship between HEI-2020, AHEI, and osteoporotic fracture risk.

Results

After full adjustment for confounding factors, each 1-point increase in HEI-2020 and AHEI scores was associated with a 1.5% (OR = 0.985, 95% CI: 0.978–0.992) and 1.3% (OR = 0.987, 95% CI: 0.980–0.994) reduction in osteoporotic fracture risk, respectively. RCS analysis indicated that both HEI-2020 (p for nonlinear = 0.2911) and AHEI (p for nonlinear = 0.3951) were linearly and inversely associated with osteoporotic fracture risk (all P overall < 0.0001). Subgroup analyses showed that this association remained consistent across populations stratified by sex, age, BMI, smoking status, hypertension, diabetes, and cardiovascular disease, with no significant interactions observed. Sensitivity analyses excluding participants who reported the use of prescription medications for hypertension or diabetes yielded results consistent with the primary analyses after multivariable adjustment.

Conclusion

This study systematically showed a significant inverse association between HEI-2020, AHEI, and osteoporotic fracture risk. The findings suggest that improving diet quality may be a feasible strategy for preventing osteoporotic fractures, with broad population applicability and public health implications.