Associations between combined dietary inflammatory and oxidative stress risk scores and osteoporosis: A population-based analysis of graded risk

Summary: This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) to examine the association between the dietary inflammatory index (DII) and dietary oxidative balance score (DOBS) with osteoporosis risk using multivariable logistic regression models. The results showed that a high DII and low DOBS were significantly associated with increased osteoporosis risk, particularly in women. Purpose: This cross-sectional study aimed to investigate the association between dietary inflammatory potential, as measured by the dietary inflammatory index (DII), and dietary oxidative balance score (DOBS), with osteoporosis risk in a large, nationally representative sample. Gender-specific analyses were conducted to assess potential differences in these associations. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) cycles 2007–2008, 2009–2010, 2013–2014, and 2017–2018 were utilized, including 10,709 participants. DII and DOBS scores were calculated based on 24-hour dietary recalls, and participants were stratified into composite dietary risk groups. Osteoporosis was defined based on dual-energy X-ray absorptiometry (DXA) measurements. Multivariable logistic regression models were used to estimate the odds ratios (ORs) for osteoporosis across dietary risk groups, adjusting for demographic, lifestyle, and clinical factors. Subgroup analyses were conducted for male and female participants. Results: In the overall participants, participants in the high-risk dietary group (high DII, low DOBS) had a significantly higher odds of osteoporosis compared to the low-risk group (Model 3: OR: 2.31, 95% CI: 1.39-3.85, P = 0.002). In gender-stratified analyses, women in the high-risk group had a more than twofold increased odds of osteoporosis compared to the low-risk group (Model 3: OR: 2.71, 95% CI: 1.49–4.93, P = 0.002), whereas in men, the association between dietary risk groups and osteoporosis was not statistically significant (Model 3: OR: 1.61, 95% CI: 0.73–3.57, P = 0.235). Conclusion: Dietary patterns with high inflammatory potential and low antioxidant intake are associated with an increased risk of osteoporosis, particularly in women. Given the cross-sectional design, causal relationships cannot be established, and prospective studies are warranted to further clarify these associations.