Associations between dietary oxidative balance score and osteoporosis among U.S. adults over 60 years of age: A cross-sectional analysis

Osteoporosis is prevalent among older adults, and the dietary oxidative balance score (DOBS) is increasingly being recognized as a key determinant of its development. To further explore this association, we analyzed a comprehensive dataset obtained from the National Health and Nutrition Examination Survey, with a specific focus on a representative sample of the elderly population in the United States. This population-based study analyzed data obtained from elderly participants (≥60 years) across multiple National Health and Nutrition Examination Survey cycles (2005-2010, 2013-2014, and 2017-2020). Multivariable logistic regression models were used to evaluate the DOBS-osteoporosis association, and linear regression was used to assess the DOBS-bone mineral density (BMD) relationships. Nonlinear associations were investigated using restricted cubic spline regression and generalized additive modeling approaches. This study ultimately included 8112 participants, of whom 1516 (20.06%, weighted) were diagnosed with osteoporosis. After adjusting for all covariates, the weighted multivariable logistic regression model identified low DOBS as an independent risk factor for osteoporosis (odds ratios: 1.73; 95% confidence intervals: 1.26-2.36; P = .001). Restricted cubic spline indicated an inverse linear relationship between DOBS and osteoporosis risk in elderly individuals (nonlinear P-value = .322). Furthermore, the weighted linear regression models showed a positive correlation between DOBS and BMD in both the femoral neck and lumbar spine regions. These findings suggest that higher levels of DOBS show a strong negative relationship with osteoporosis prevalence and are positively linked to BMD in older U.S. adults. This epidemiological evidence implies that nutritional regimens with abundant antioxidant components are associated with skeletal integrity in aging populations.