Adiposity indices and bone health amongst Malaysian adults: Evidence from a cross‑sectional study

The relationship between adiposity and bone health is controversial because of the various direct and indirect bone regulatory functions of adipose tissue. Given the limitations of the body mass index (BMI) as a reliable marker of adiposity, several alternative indices have been developed. The different indices show varying associations with bone health. The present study aimed to determine the association between various adiposity indices and bone health amongst Malaysians. In October and November 2024, this cross-sectional study recruited 320 subjects (231 women and 89 men) from a bone health screening event via purposive sampling. The subjects' body weight, height, and waist and hip circumference were measured, and adiposity indices [BMI, waist-to-hip ratio (WHR), waist-to-height ratio (WtHR), body roundness index (BRI), conicity index (CI) and a body shape index (ABSI)] were derived from these basic parameters. The subjects' bone health was evaluated by using a calcaneal bone quantitative ultrasonometer-derived osteoporosis index (OI). Linear regression analysis was used to determine the relationship between adiposity indices and bone health after adjustment for potential confounders. The strength of association was indicated as beta coefficient (β). The results indicated that after adjustment for confounders, a significant relationship existed between the OI and all adiposity indices, with the exception of CI. The BMI (β=0.172, P<0.001), waist circumference (β=0.184, P=0.001), WHR (β=0.124, P=0.025), WtHR (β=0.160, P=0.002) and BRI (β=0.165, P=0.001) showed a positive association with bone health, whereas the ABSI (β=-0.183, P=0.008) showed a negative association. In conclusion, adiposity indices associated with body size showed a positive relationship with bone health, whereas the ABSI, which has already been adjusted for body size, showed a negative relationship with bone health.