{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:13:13Z","timestamp":1787026393855,"version":"build-2736575974"},"reference-count":74,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T00:00:00Z","timestamp":1743984000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Despite accumulating evidence on central obesity and osteoporosis, the role of a body shape index (ABSI), a nonlinear index quantifying body shape via body mass index (BMI), waist circumference (WC), and height, remains controversial and underexplored. Although recent meta-analyses suggest central obesity may modulate fracture risk bidirectionally, no research has comprehensively compared ABSI with traditional adiposity metrics, such as BMI, WC, and waist-to-height ratio (WHtR), to predict site-specific changes in bone mineral density (BMD) across anatomical regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study utilized National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018, involving 12,421 participants. ABSI was computed using the formula: ABSI = WC\/(BMI\u00b2\/\u00b3 \u00d7 Height\u00b9\/\u00b2). BMD was assessed at four sites\u2014the total femur (TF), femoral neck (FN), trochanter (TR), and intertrochanter (IN) regions\u2014via dual-energy X-ray absorptiometry (DXA). The association between ABSI and BMD was analyzed via multiple regression models and a generalized additive model (GAM). To compare ABSI\u2019s predictive efficacy with conventional adiposity indices, regression analyses juxtaposed ABSI against BMI, WC, and WHtR in assessing correlations with site-specific BMD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After full covariate adjustment, a significant negative association was observed between ABSI and BMD in four femoral regions (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.01). Smoothed curve fitting revealed a significant nonlinear relationship and threshold effect between ABSI and BMD among middle-aged and older individuals. Additionally, an inverted J-shaped curve was observed between ABSI and BMD in all four femoral regions. Meanwhile, ABSI showed significant negative associations with BMD across all femoral sites (\u03b2 = -0.27 to -0.31,\n                      <jats:italic>p<\/jats:italic>\n                      -trend&amp;lt; 0.000001), whereas BMI, WC, and WHtR exhibited positive correlations (WHtR showing the strongest effect: \u03b2 = 0.41\u20130.69). This highlights ABSI\u2019s ability to detect central adiposity-related bone loss obscured by conventional obesity metrics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ABSI\u2019s robust inverse associations with femoral BMD (\u03b2 = -0.27 to -0.31), persisting across nonlinear threshold analyses, establish it as a novel biomarker of central adiposity-related skeletal fragility. Unlike conventional indices reflecting mechanical loading benefits (BMI \u03b2 = 0.008\u20130.012; WC \u03b2 = 0.003\u20130.005; WHtR \u03b2 = 0.41\u20130.69), ABSI specifically captures visceral fat-driven metabolic disorder\u2014a critical pathway for osteoporosis risk stratification in normal-weight and obese populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1506841","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T00:10:50Z","timestamp":1743984650000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Association between A body shape index and bone mineral density in middle-aged and elderly adults: a retrospective analysis of NHANES 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