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Metabolic factors like serum uric acid (UA) and high-density lipoprotein cholesterol (HDL-C) have emerged as possible determinants of bone health. The uric acid to HDL cholesterol ratio (UHR) may offer a new perspective on these metabolic influences. This study explores the association between UHR and femoral neck BMD, with a focus on non-linear relationships and subgroup variations by body mass index (BMI), age, and sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study used data from 2178 participants from the 2017\u20132018 National Health and Nutrition Examination Survey (NHANES). UHR was calculated as the ratio of serum UA to HDL-C. BMD measurements were obtained using dual-energy X-ray absorptiometry (DXA) at the femoral neck. A two-piecewise linear regression model was applied to examine the non-linear relationship between UHR and BMD. Stratified analyses were conducted by BMI, gender, and age groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A significant inflection point was found at UHR\u200919. Below this threshold, UHR was positively associated with femoral neck BMD (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.0054,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013), while above the threshold, the association was negative but not statistically significant (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u2212\u00a00.0016,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.478). Stratified analysis revealed that the relationship between UHR and BMD remained significant among Mexican Americans even after adjusting for covariates (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.0145,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study identifies a non-linear association between UHR and femoral neck BMD, with a key inflection point at UHR\u200919. These findings suggest that UHR could be a useful biomarker for bone health, especially in populations with higher metabolic risks. Further longitudinal studies are necessary to establish causality and explore potential interventions targeting UHR to improve bone health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40001-025-03200-3","type":"journal-article","created":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T05:47:26Z","timestamp":1762580846000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Non-linear associations between UHR and bone mineral density in US adults: NHANES 2017\u20132018"],"prefix":"10.1186","volume":"30","author":[{"given":"Han","family":"Wen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minfeng","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huifang","family":"Niu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huazhen","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,8]]},"reference":[{"issue":"5","key":"3200_CR1","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1007\/s11926-020-00892-w","volume":"22","author":"TM Link","year":"2020","unstructured":"Link TM, Kazakia G. 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