{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:12:15Z","timestamp":1788502335455,"version":"build-2803163510"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"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>Background<\/jats:title>\n                    <jats:p>Osteoporosis is a major global public health challenge, with lifestyle as a key modifiable factor. This study aimed to examine associations between lifestyle patterns and bone mineral density (BMD) in Chinese adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cross-sectional, multi-center study, 5,324 adults from Beijing (2016\u20132020) with complete lifestyle questionnaires were analyzed (lumbar spine BMD available for 4,028; hip BMD available for 4,654). Each of eight lifestyle variables was residualized on age and sex before k-means clustering (k = 3) categorized participants into three groups: office\/mental-labor workers with low leisure-time activity (OL), physical-labor workers (PL), and office\/mental-labor workers with an active leisure-time lifestyle (OA). Differences in lumbar spine and hip BMD among clusters were examined using multivariable-adjusted models (age modeled via restricted cubic spline, sex, body mass index [BMI], hospital fixed effects), with stratification by sex, age group, and BMI group, alongside full-cohort dose-response and cluster \u00d7 exposure interaction analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After adjustment, the OA cluster showed higher lumbar spine BMD than the OL cluster (adjusted difference = 0.024 g\/cm\n                      <jats:sup>2<\/jats:sup>\n                      , 95% CI 0.012\u20130.036,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001). The PL cluster showed lower hip BMD than both the OL cluster (adjusted difference = \u22120.041 g\/cm\n                      <jats:sup>2<\/jats:sup>\n                      , 95% CI \u22120.056 to \u22120.027,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001) and the OA cluster (adjusted difference = 0.028 g\/cm\n                      <jats:sup>2<\/jats:sup>\n                      , 95% CI 0.011\u20130.044,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.002), despite the occupational physical activity inherent to manual labor. These associations were broadly consistent across sex, age, and BMI strata, though attenuated among participants aged \u226570 years and those with obesity. In dose-response analyses, exercise and sun exposure showed non-linear associations with BMD at both sites, while calcium supplementation frequency showed a consistent negative linear association that did not vary by cluster.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A lifestyle pattern combining active leisure-time behavior with office-based occupation was associated with higher lumbar spine BMD, while an occupationally physical-labor lifestyle was associated with lower hip BMD relative to both other clusters. These associations exhibited site-specific patterns and were generally consistent across demographic subgroups. Given the cross-sectional design, these findings should be interpreted as associations rather than causal effects; prospective studies are needed to clarify their causal structure and clinical significance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1904158","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:23:58Z","timestamp":1788499438000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Lifestyle clusters and bone mineral density in Chinese adults: a cross-sectional study with cluster analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Senyang","family":"Lei","sequence":"first","affiliation":[{"name":"Outpatient Department, Air Force Medical Center, PLA","place":["Beijing, China"]},{"name":"Beijing National Day School","place":["Beijing, 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