Association of visceral fat metabolic score with bone mineral density and osteoporosis: a NHANES cross-sectional study

Abstract Background Metabolic Score for Visceral Fat (METS-VF) is commonly used as an indicator for assessing visceral fat metabolism. However, the relationship between METS-VF, Bone Mineral Density (BMD), and osteoporosis remains unclear in the American population. Methods This study utilized cross-sectional data from the National Health and Nutrition Examination Survey (NHANES), including participants aged 20 years and older, from the survey cycles conducted between 2005 and 2010, 2013–2014, and 2017–2018. Multivariable weighted linear regression and logistic regression analyses were first applied to investigate the associations between the METS-VF, femoral BMD, and osteoporosis. In addition, subgroup interaction analyses were performed to evaluate the robustness of these associations. To address potential non-linear relationships, restricted cubic spline regression was employed. All statistical analyses were conducted using R software version 4.3.3. P values were two-tailed, with P < 0.05 considered statistically significant. Results After adjusting for all covariates, the positive correlations between METS-VF and BMD measurements at all sites remained statistically significant (p < 0.001 & p for trend < 0.001). Multivariable logistic regression analysis indicated that, after adjusting for covariates related to osteoporosis, each one-unit increase in METS-VF was associated with a 63.1% reduction in the risk of developing osteoporosis. Moreover, the direction of the associations between METS-VF and both BMD and osteoporosis remained consistent across all subgroups, while restricted cubic spline (RCS) analyses suggested nonlinear relationships. The 5.82–7.35 METS-VF range yielded a mean 51.9% osteoporosis risk reduction (sustained ≥ 30% peak efficacy in 66.7% of participants). Conclusions METS-VF demonstrated a nonlinear positive association with BMD and a nonlinear inverse relationship with osteoporosis risk. Future studies should establish optimal biological thresholds of METS-VF for skeletal health. Clinical trial number Not applicable.