{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T10:25:44Z","timestamp":1793787944533,"version":"4.6.1"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Currently, the relationship between socioeconomic status (SES) and trabecular bone score (TBS) remains unclear. This study uses existing data from the National Health and Nutrition Examination Survey (NHANES) to test the hypothesis that SES, measured by the poverty income ratio (PIR), is associated with TBS among adults in the United States of America.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study analyzed the relationship between SES and TBS in 7,832 adults using data from the 2005\u20132008 NHANES. The TBS data were obtained from pre-existing lumbar spine DXA scans collected in the NHANES database. The study employed a multivariable linear regression model, adjusting for various confounding factors, to examine the association between the PIR and TBS. Additionally, demographic characteristics were described, stratified analyses, single factor analysis, smooth curve fitting, and interaction analysis were conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Results showed that PIR was positively correlated with TBS (\u03b2\u2009=\u20090.0019, 95% CI 0.0002\u20130.0035, P\u2009&lt;\u20090.05), and high-income individuals had a TBS 0.018 higher than low-income individuals (95% CI 0.0106\u20130.0254, P\u2009&lt;\u20090.001). Smooth curve fitting analysis revealed a linear relationship between PIR and TBS. Stratified analysis showed that this positive correlation was particularly evident among adults aged 50 and older, observed specifically in Mexican Americans and individuals of European and African ancestry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our research shows that there is a significant positive correlation between adult SES and TBS. Higher household income levels correspond to better TBS levels, which can help prevent osteoporosis and fractures. When developing strategies for the prevention and treatment of osteoporosis, healthcare professionals and policymakers should consider the impact of socioeconomic inequalities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0338378","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T18:28:40Z","timestamp":1765564120000},"page":"e0338378","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Unveiling the wealth-bone connection: How socioeconomic status influences trabecular bone health"],"prefix":"10.1371","volume":"20","author":[{"given":"Yuan","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingxiao","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanlei","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0244-2739","authenticated-orcid":true,"given":"Qice","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"issue":"6","key":"pone.0338378.ref001","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/0002-9343(93)90218-E","article-title":"Consensus development conference: Diagnosis, prophylaxis, and treatment of osteoporosis","volume":"94","year":"1993","journal-title":"Am J Med"},{"issue":"10","key":"pone.0338378.ref002","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1002\/jbmr.2531","article-title":"Intervention thresholds and the diagnosis of osteoporosis","volume":"30","author":"JA Kanis","year":"2015","journal-title":"J Bone Miner Res"},{"issue":"2","key":"pone.0338378.ref003","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1097\/JS9.0000000000000883","article-title":"Trends in prevalence of fractures among adults in the United States, 1999-2020: a population-based study","volume":"110","author":"B Xu","year":"2024","journal-title":"Int J Surg"},{"key":"pone.0338378.ref004","doi-asserted-by":"crossref","first-page":"882241","DOI":"10.3389\/fendo.2022.882241","article-title":"The Global Burden of Osteoporosis, Low Bone Mass, and Its Related Fracture in 204 Countries and Territories, 1990-2019","volume":"13","author":"Y Shen","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"pone.0338378.ref005","article-title":"The Epidemiology and Pathogenesis of Osteoporosis.","volume-title":"Endotext","author":"CJ. 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Shevroja","year":"2023","journal-title":"Osteoporos Int"},{"issue":"3","key":"pone.0338378.ref008","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1007\/s00198-018-4405-0","article-title":"Risk-equivalent T-score adjustment for using lumbar spine trabecular bone score (TBS): the Manitoba BMD registry","volume":"29","author":"WD Leslie","year":"2018","journal-title":"Osteoporos Int"},{"issue":"3","key":"pone.0338378.ref009","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.jocd.2017.06.019","article-title":"Use of trabecular bone score (TBS) as a Complementary approach to dual-energy X-ray Absorptiometry (DXA) for fracture risk assessment in clinical practice","volume":"20","author":"E Shevroja","year":"2017","journal-title":"J Clin Densitom"},{"issue":"2","key":"pone.0338378.ref010","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1377\/hlthaff.21.2.60","article-title":"Socioeconomic disparities in health: pathways and 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