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Objective <p>To identify the determinants of osteoporosis (OP) among older adults in China and develop a nomogram-based risk-assessment tool for clinical screening.</p> Methods <p>We retrospectively enrolled 8,243 consecutive older adults who underwent routine physical examinations at the Health Management Center of the First Affiliated Hospital of the University of Science and Technology of China between January 2023 and June 2025. After classifying participants into OP (<i>n =</i> 4,302) and non-OP (<i>n =</i> 3,941) groups according to bone mineral density measurements, we collected baseline demographic information, clinical history, and routine biochemical indices. Variables selection were selected via LASSO regression; subsequently, multivariable logistic regression was applied to identify independent risk factors for OP. A screening nomogram was constructed from these variables and internally validated through 1,000-replicate bootstrapping; discrimination (ROC curve), calibration (Hosmer–Lemeshow test and calibration plot), and clinical utility (decision curve analysis [DCA]) were assessed.</p> Results <p>Multivariable analysis revealed that female sex, increasing age, diabetes mellitus, and prior fracture history were independently associated with higher odds of OP (OR &gt; 1 and all <i>P &lt;</i> 0.05). Conversely, higher body mass index (BMI), serum uric acid, serum calcium and vitamin D levels were linked to reduced odds (OR &lt; 1 and all <i>P &lt;</i> 0.05). The nomogram achieved an AUC of 0.799 (95% CI: 0.789–0.808); calibration plots aligned closely with the ideal line (Hosmer–Lemeshow <i>P =</i> 0.796), while DCA indicated net clinical benefit between risk thresholds of 13% and 89%. After bootstrapping, the AUC remained stable at 0.788 (95%CI: 0.779–0.797).</p> Conclusion <p>Female sex, advancing age, diabetes mellitus, prior fracture history, BMI, serum uric acid, serum calcium and vitamin D are independent determinants of OP in older adults.The nomogram built on these factors offers satisfactory screening accuracy and may assist clinicians in identifying individuals at an elevated risk for osteoporosis to guide personalized preventive strategies.</p>

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Development and validation of an osteoporosis risk-assessment model for Chinese older adults: a large-scale retrospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月9日

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  • Ming Xu,
  • Xiang Ni,
  • Li-xiang Zhang,
  • Ling-yun Tian,
  • Xin-min Chu

摘要

Objective

To identify the determinants of osteoporosis (OP) among older adults in China and develop a nomogram-based risk-assessment tool for clinical screening.

Methods

We retrospectively enrolled 8,243 consecutive older adults who underwent routine physical examinations at the Health Management Center of the First Affiliated Hospital of the University of Science and Technology of China between January 2023 and June 2025. After classifying participants into OP (n = 4,302) and non-OP (n = 3,941) groups according to bone mineral density measurements, we collected baseline demographic information, clinical history, and routine biochemical indices. Variables selection were selected via LASSO regression; subsequently, multivariable logistic regression was applied to identify independent risk factors for OP. A screening nomogram was constructed from these variables and internally validated through 1,000-replicate bootstrapping; discrimination (ROC curve), calibration (Hosmer–Lemeshow test and calibration plot), and clinical utility (decision curve analysis [DCA]) were assessed.

Results

Multivariable analysis revealed that female sex, increasing age, diabetes mellitus, and prior fracture history were independently associated with higher odds of OP (OR > 1 and all P < 0.05). Conversely, higher body mass index (BMI), serum uric acid, serum calcium and vitamin D levels were linked to reduced odds (OR < 1 and all P < 0.05). The nomogram achieved an AUC of 0.799 (95% CI: 0.789–0.808); calibration plots aligned closely with the ideal line (Hosmer–Lemeshow P = 0.796), while DCA indicated net clinical benefit between risk thresholds of 13% and 89%. After bootstrapping, the AUC remained stable at 0.788 (95%CI: 0.779–0.797).

Conclusion

Female sex, advancing age, diabetes mellitus, prior fracture history, BMI, serum uric acid, serum calcium and vitamin D are independent determinants of OP in older adults.The nomogram built on these factors offers satisfactory screening accuracy and may assist clinicians in identifying individuals at an elevated risk for osteoporosis to guide personalized preventive strategies.