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However, its prevalence and risk factors in older adults undergoing CKD G5D are still poorly understood. This study aimed to investigate the prevalence and independent risk factors of CKD-associated osteoporosis in CKD G5D patients aged over 50 years in Hainan General hospital to guide targeted prevention and management strategies. This cross-sectional study enrolled 258 CKD G5D patients from Hainan General hospital (May 2023\u2013October 2024). Bone mineral density at the lumbar spine, femoral neck, and total hip was measured using dual-energy X-ray absorptiometry. CKD-associated osteoporosis was defined as a T-score\u2009\u2264\u2009\u2212\u20092.5 or the presence of a fragility fracture. Demographic data, body measurements, and laboratory results were collected and analyzed. Variable selection was performed using a combination of LASSO regression and univariate logistic regression, followed by multivariate logistic regression to identify independent risk factors. Among the participants, 109 (42.3%) were diagnosed with CKD-associated osteoporosis. Multivariable logistic regression analysis identified female (OR\u2009=\u20093.44, 95%CI: 1.77\u20136.80,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.01), decreased grip strength (per 1\u00a0kg decrease) (OR\u2009=\u20091.05, 95%CI: 1.00-1.09,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.05), and decreased albumin levels (per 1\u00a0g\/L decrease) (OR\u2009=\u20091.11, 95%CI: 1.01\u20131.22,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.03) as independent risk factors for CKD-associated osteoporosis. CKD-associated osteoporosis is highly prevalent in CKD G5D patients over 50 years old, especially in females with low grip strength and low albumin levels. This highlights the need for enhanced screening of high-risk groups and integrating muscle function training and nutritional interventions into CKD-associated osteoporosis management.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-35136-x","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T09:35:55Z","timestamp":1767951355000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prevalence and risk factors of CKD-associated osteoporosis in maintenance hemodialysis patients aged over 50 years: a cross-sectional study"],"prefix":"10.1038","volume":"16","author":[{"given":"Yafei","family":"Bai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyu","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"An","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunli","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yajun","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruman","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"35136_CR1","first-page":"e18488","volume":"13","author":"N Tasnim","year":"2021","unstructured":"Tasnim, N. et al. Osteoporosis, an inevitable circumstance of chronic kidney disease: A systematic review. Cureus 13, e18488 (2021).","journal-title":"Cureus"},{"key":"35136_CR2","doi-asserted-by":"publisher","first-page":"1975","DOI":"10.1016\/S0140-6736(14)61601-9","volume":"385","author":"T Liyanage","year":"2015","unstructured":"Liyanage, T. et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet 385, 1975\u20131982 (2015).","journal-title":"Lancet"},{"key":"35136_CR3","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.1001\/jama.2024.16338","volume":"332","author":"JE Flythe","year":"2024","unstructured":"Flythe, J. E. & Watnick, S. Dialysis for chronic kidney failure. JAMA 332, 1559 (2024).","journal-title":"JAMA"},{"key":"35136_CR4","doi-asserted-by":"publisher","first-page":"891363","DOI":"10.3389\/fmed.2022.891363","volume":"9","author":"P-Y Wu","year":"2022","unstructured":"Wu, P-Y. et al. Role of fracture risk assessment tool and bone turnover markers in predicting All-Cause and cardiovascular mortality in Hemodialysis patients. Front. Med. 9, 891363 (2022).","journal-title":"Front. Med."},{"key":"35136_CR5","doi-asserted-by":"publisher","first-page":"2200846","DOI":"10.1080\/0886022X.2023.2200846","volume":"45","author":"Y Wang","year":"2023","unstructured":"Wang, Y. et al. Interrelationships between sarcopenia, bone turnover markers and low bone mineral density in patients on Hemodialysis. Ren. Fail. 45, 2200846 (2023).","journal-title":"Ren. Fail."},{"key":"35136_CR6","doi-asserted-by":"publisher","first-page":"2031","DOI":"10.2147\/JMDH.S457193","volume":"17","author":"X Liu","year":"2024","unstructured":"Liu, X. et al. The relationship between fracture and mortality in a Chinese maintenance Hemodialysis patients cohort. 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