{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:10:47Z","timestamp":1779253847019,"version":"3.51.4"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"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. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The association between long-term high-altitude residence and osteoporosis remains unclear. This study investigated whether body mass index (BMI) and vitamin D status modify the association between residential altitude and dual-energy X-ray absorptiometry (DXA)-defined osteoporosis among long-term residents of the Qinghai\u2013Tibetan Plateau. In resource-limited high-altitude settings, limited access to DXA may hinder timely osteoporosis detection, and opportunistic use of routine computed tomography (CT), together with simple host characteristics such as BMI, may support pragmatic risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A single-centre, hospital-based retrospective case\u2013control study was conducted among residents aged \u226550\u202fyears who had undergone non-contrast CT and DXA within 30\u202fdays and had lived on the Qinghai\u2013Tibetan Plateau for \u22655\u202fyears. Osteoporosis was defined as a DXA T-score \u2264\u202f\u2212\u202f2.5, and individuals with osteopenia were excluded to increase phenotypic contrast. Residential altitude (1,500\u20134,600\u202fm) was geocoded and analysed as a continuous variable per 100\u202fm increment. Pre-specified interaction terms included residential altitude \u00d7 BMI and residential altitude \u00d7 25-hydroxyvitamin D [25(OH)D]. Additional BMI-stratified analyses used 24.0\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      as a clinically interpretable threshold. Exploratory HU-adjusted sensitivity analyses are reported in the\n                      <jats:xref>Supplementary materials<\/jats:xref>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 377 participants (224 osteoporosis cases and 153 controls with normal bone mineral density), residential altitude was not independently associated with osteoporosis after multivariable adjustment (adjusted odds ratio [aOR] 1.020 per 100\u202fm, 95% CI 0.976\u20131.065;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.374). In the primary interaction model, there was suggestive but inconclusive evidence of BMI-related heterogeneity (altitude \u00d7 BMI aOR 1.011, 95% CI 0.998\u20131.023;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.087), whereas no interaction with 25(OH)D was observed (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.423). BMI-stratified analyses showed directionally different but imprecise altitude\u2013osteoporosis associations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Residential altitude was not independently associated with osteoporosis in this hospital-based case\u2013control study of long-term plateau residents. The data suggested possible BMI-related heterogeneity, but the evidence was inconclusive and should be interpreted cautiously. These findings are hypothesis-generating and may inform future opportunistic bone health assessment in resource-limited high-altitude settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1844263","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T04:46:15Z","timestamp":1779252375000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Residential altitude was not independently associated with osteoporosis among long-term Qinghai\u2013Tibetan Plateau residents"],"prefix":"10.3389","volume":"14","author":[{"given":"Zhibin","family":"Liu","sequence":"first","affiliation":[{"name":"College of Clinical Medicine, Qinghai University","place":["Xining, Qinghai, China"]},{"name":"Department of Spine Surgery, Qinghai Provincial People's Hospital","place":["Xining, Qinghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Qinghai Branch, The First Affiliated Hospital of Xi\u2019an Jiaotong University","place":["Xining, Qinghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuzhuo","family":"Zhang","sequence":"additional","affiliation":[{"name":"College of Clinical Medicine, Qinghai University","place":["Xining, Qinghai, China"]},{"name":"Department of Spine Surgery, Qinghai Provincial People's Hospital","place":["Xining, Qinghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Honghao","family":"Dai","sequence":"additional","affiliation":[{"name":"College of Clinical Medicine, Qinghai University","place":["Xining, Qinghai, China"]},{"name":"Department of Spine Surgery, Qinghai Provincial People's Hospital","place":["Xining, Qinghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junlong","family":"Huang","sequence":"additional","affiliation":[{"name":"College of Clinical Medicine, Qinghai University","place":["Xining, Qinghai, China"]},{"name":"Department of Spine Surgery, Qinghai Provincial People's Hospital","place":["Xining, Qinghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qianfu","family":"Gong","sequence":"additional","affiliation":[{"name":"College of Clinical Medicine, Qinghai University","place":["Xining, Qinghai, China"]},{"name":"Department of Spine Surgery, Qinghai Provincial People's Hospital","place":["Xining, Qinghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dajie","family":"Suonan","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Qinghai Provincial People's Hospital","place":["Xining, Qinghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhongshu","family":"Shan","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Qinghai Provincial People's Hospital","place":["Xining, Qinghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e873","DOI":"10.1016\/S2665-9913(25)00105-5","article-title":"The global, regional, and national burden attributable to low bone mineral density, 1990-2020: an analysis of a modifiable risk factor from the Global Burden of Disease Study 2021","volume":"7","year":"2025","journal-title":"Integr Comp Biol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e580","DOI":"10.1016\/S2666-7568(21)00172-0","article-title":"Global, regional, and national burden of bone fractures in 204 countries and territories, 1990-2019: a systematic analysis from the 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