{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:31:20Z","timestamp":1753893080647,"version":"3.41.2"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T00:00:00Z","timestamp":1739232000000},"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. Aging"],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study aimed to investigate the relationship between albumin-corrected anion gap (ACAG) and lumbar spine bone mineral density (BMD) in a diverse population, assessing how variations in ACAG levels correlate with changes in lumbar spine BMD and the potential implications for osteoporosis risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional analysis was conducted involving 3,057 participants (1,555 males and 1,502 females). Participants were stratified into quartiles based on baseline ACAG levels. Demographic and clinical characteristics were analyzed, including age, sex, education level, body mass index (BMI), and prevalence of diabetes and hypertension. The association between ACAG and lumbar spine BMD was evaluated using multiple regression models, and a generalized additive model was employed to identify potential nonlinear relationships.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The analysis revealed a significant negative correlation between ACAG and lumbar spine BMD (<jats:italic>P<\/jats:italic> &amp;lt; 0.001). For each 1-unit increase in ACAG, BMD decreased with \u03b2 coefficients of \u22120.004 to \u22120.005 across various models. Quartile analysis indicated that participants in the highest ACAG quartile (\u226519.55) experienced the most substantial reductions in BMD (\u03b2 coefficients ranging from \u22120.034 to \u22120.036, <jats:italic>P<\/jats:italic> &amp;lt; 0.001). Furthermore, a U-shaped relationship was identified, with a turning point at an ACAG value of 22.15, indicating that lower ACAG levels were associated with decreased BMD, while higher levels showed a positive effect. Subgroup analyses by sex demonstrated consistent findings, with significant associations in both males and females.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The findings underscore a significant association between elevated ACAG levels and reduced lumbar spine BMD, suggesting that ACAG may serve as a valuable biomarker for assessing osteoporosis risk. The identified nonlinear relationship further emphasizes the complexity of metabolic influences on bone health. These results warrant further investigation into the mechanisms underlying ACAG\u2019s impact on bone density and its potential role in osteoporosis prevention strategies.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fragi.2025.1511294","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T07:06:31Z","timestamp":1739257591000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Relationship between albumin-corrected anion gap and lumbar spine bone mineral density: a cross-sectional study"],"prefix":"10.3389","volume":"6","author":[{"given":"Aiguo","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ting","family":"Ying","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuang","family":"Deng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chenxu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziwen","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sitong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chengqing","family":"Yi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dejian","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,2,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"0","DOI":"10.21608\/jes.2022.122375.1181","article-title":"A study of osteoporosis in Egyptian premenopausal women in urban and rural areas","author":"Abd Elsalam","year":"2022","journal-title":"J. Environ. Sci."},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-67681\/v1","article-title":"The impact of type 2 diabetes mellitus on the markers of osteoporosis (sclerostin and CTRP3) in postmenopausal women: a comparative","author":"Ahmad","year":"2020","journal-title":"Obs. Study"},{"key":"B3","doi-asserted-by":"publisher","first-page":"323","DOI":"10.14744\/tjtes.2024.48409","article-title":"The role of bone turnover markers in diagnosis, monitoring, and pathological fractures of osteoporosis","volume":"30","author":"Alt\u0131nsoy","year":"2024","journal-title":"Ulus. Travma Acil Cerrahi Derg."},{"key":"B4","doi-asserted-by":"publisher","first-page":"263","DOI":"10.11005\/jbm.2023.30.3.263","article-title":"Osteoporosis feature selection and risk prediction model by machine learning using a cross-sectional database","volume":"30","author":"Cha","year":"2023","journal-title":"J. Bone Metab."},{"key":"B5","doi-asserted-by":"publisher","first-page":"2848","DOI":"10.3390\/nu11122848","article-title":"Nutritional support and physical modalities for people with osteoporosis: current opinion","volume":"11","author":"Chen","year":"2019","journal-title":"Nutrients"},{"key":"B6","doi-asserted-by":"publisher","first-page":"6501272","DOI":"10.1155\/2020\/6501272","article-title":"Serum anion gap predicts all-cause mortality in critically ill patients with acute kidney injury: analysis of the MIMIC-III database","volume":"2020","author":"Cheng","year":"2020","journal-title":"Dis. Markers"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2503","DOI":"10.1038\/s41598-018-20896-y","article-title":"High dietary salt intake correlates with modulated Th17-Treg cell balance resulting in enhanced bone loss and impaired bone-microarchitecture in male mice","volume":"8","author":"Dar","year":"2018","journal-title":"Sci. Rep."},{"key":"B8","doi-asserted-by":"publisher","first-page":"46","DOI":"10.17826\/cumj.1173429","article-title":"Delta values as a prognostic marker in methanol poisoning: a retrospective cohort study","volume":"48","author":"Duyan","year":"2023","journal-title":"Cukurova Med. J."},{"key":"B9","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1186\/s12882-018-0934-1","article-title":"Changes in bone mineral density after total parathyroidectomy without autotransplantation in the end-stage renal disease patients with secondary hyperparathyroidism","volume":"19","author":"Fang","year":"2018","journal-title":"BMC Nephrol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"94","DOI":"10.6118\/jmm.20036","article-title":"Effect of alkaline drinking water on bone density of postmenopausal women with osteoporosis","volume":"27","author":"Fasihi","year":"2021","journal-title":"J. Menopausal Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"2282708","DOI":"10.1080\/0886022X.2023.2282708","article-title":"Association between albumin corrected anion gap and all-cause mortality in critically ill patients with acute kidney injury: a retrospective study based on MIMIC-IV database","volume":"45","author":"Gao","year":"2023","journal-title":"Ren. Fail."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e16096","DOI":"10.1097\/MD.0000000000016096","article-title":"A community-based study of the relationship between calcaneal bone mineral density and systemic parameters of blood glucose and lipids","volume":"98","author":"Gu","year":"2019","journal-title":"Medicine"},{"key":"B13","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1136\/adc.87.6.526","article-title":"Correction of the anion gap for albumin in order to detect occult tissue anions in shock","volume":"87","author":"Hatherill","year":"2002","journal-title":"Arch. Dis. Child."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1099003","DOI":"10.3389\/fcvm.2023.1099003","article-title":"Elevated albumin corrected anion gap is associated with poor in-hospital prognosis in patients with cardiac arrest: a retrospective study based on MIMIC-IV database","volume":"10","author":"Hu","year":"2023","journal-title":"Front. Cardiovasc Med."},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-858125\/v2","article-title":"Lower geriatric nutritional risk index are associated with A higher incidence of osteoporosis in northern China type 2","author":"Ji","year":"2022","journal-title":"Diabetes"},{"key":"B16","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1186\/s12872-023-03200-3","article-title":"Association between albumin corrected anion gap and 30-day all-cause mortality of critically ill patients with acute myocardial infarction: a retrospective analysis based on the MIMIC-IV database","volume":"23","author":"Jian","year":"2023","journal-title":"BMC Cardiovasc Disord."},{"key":"B17","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1177\/1054773819865874","article-title":"The application of PRECEDE model on preventing osteoporosis in women","volume":"30","author":"Khani Jeihooni","year":"2021","journal-title":"Clin. Nurs. Res."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1706","DOI":"10.34067\/KID.0003562021","article-title":"Obesity, anion accumulation, and anion gap metabolic acidosis: a cohort study","volume":"2","author":"Lambert","year":"2021","journal-title":"Kidney360"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2415","DOI":"10.2147\/JIR.S412860","article-title":"Albumin corrected anion gap and the risk of in-hospital mortality in patients with acute pancreatitis: a retrospective cohort study","volume":"16","author":"Li","year":"2023","journal-title":"J. Inflamm. Res."},{"key":"B20","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1186\/s40001-024-01811-w","article-title":"Relationship between albumin-corrected anion gap and non-alcoholic fatty liver disease varied in different waist circumference groups: a cross-sectional study","volume":"29","author":"Lu","year":"2024","journal-title":"Eur. J. Med. Res."},{"key":"B21","doi-asserted-by":"publisher","first-page":"585689","DOI":"10.3389\/fendo.2020.585689","article-title":"The effect of physical activity on bone biomarkers in people with osteoporosis: a systematic review","volume":"11","author":"Marini","year":"2020","journal-title":"Front. Endocrinol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.3390\/metabo13111109","article-title":"Supplementing low-sodium bicarbonate\u2013calcic (Lete)\u00ae water: effects in women on bone and systemic metabolism","volume":"13","author":"Marino","year":"2023","journal-title":"Metabolites"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e0235042","DOI":"10.1371\/journal.pone.0235042","article-title":"Inadequate calcium and vitamin D intake and osteoporosis risk in older Americans living in poverty with food insecurities","volume":"15","author":"Marshall","year":"2020","journal-title":"PLoS ONE"},{"key":"B24","article-title":"Terati, calcium intake and body mass index (BMI) on bone density","volume-title":"Palembang","author":"Nazarena","year":"2021"},{"key":"B25","doi-asserted-by":"publisher","first-page":"2148","DOI":"10.3390\/medicina59122148","article-title":"Hand grip strength, osteoporosis, and quality of life in middle-aged and older adults","volume":"59","author":"Park","year":"2023","journal-title":"Medicina"},{"key":"B26","doi-asserted-by":"publisher","first-page":"20","DOI":"10.34067\/KID.0000842019","article-title":"The \u0394 anion gap\/\u0394 bicarbonate ratio in early lactic acidosis: time for another delta?","volume":"2","author":"Rudkin","year":"2021","journal-title":"Kidney360"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1563","DOI":"10.1177\/08850666221106413","article-title":"Relationship between the anion gap and Serum lactate in hypovolemic shock","volume":"37","author":"Rudkin","year":"2022","journal-title":"J. Intensive Care Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"193","DOI":"10.21608\/mjmr.2022.220260","article-title":"Exploring how sex difference impacts bone response to high salt diet in adult albino rats","volume":"31","author":"Saad","year":"2020","journal-title":"Minia J. Med. Res."},{"key":"B29","doi-asserted-by":"publisher","first-page":"868166","DOI":"10.3389\/fnut.2022.868166","article-title":"Impact of the malnutrition on mortality in patients with osteoporosis: a cohort study from NHANES 2005-2010","volume":"9","author":"Shangguan","year":"2022","journal-title":"Front. Nutr."},{"key":"B30","doi-asserted-by":"publisher","first-page":"e14034","DOI":"10.1111\/eci.14034","article-title":"Excessive salt intake reduces bone density in the general female population","volume":"53","author":"Takase","year":"2023","journal-title":"Eur. J. Clin. Investig."},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-3214593\/v1","article-title":"Association between the Geriatric Nutritional Risk Index and osteoporosis in patients with fragility fractures in eastern China","author":"Wang","year":"","journal-title":"Res. Square"},{"key":"B32","doi-asserted-by":"publisher","first-page":"16903","DOI":"10.1038\/s41598-023-44182-8","article-title":"The relationship between albumin corrected anion gap levels and mortality in patients with asthma in the ICU","volume":"13","author":"Wang","year":"","journal-title":"Sci. Rep."},{"key":"B33","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1038\/s42003-020-0766-y","article-title":"Quantification of aminobutyric acids and their clinical applications as biomarkers for osteoporosis","volume":"3","author":"Wang","year":"2020","journal-title":"Commun. Biol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"3663","DOI":"10.2169\/internalmedicine.1523-22","article-title":"Marked metabolic acidosis due to a transverse stoma after urethroplasty for congenital epispadias","volume":"62","author":"Yamauchi","year":"2023","journal-title":"Intern. Med."},{"key":"B35","doi-asserted-by":"publisher","first-page":"3269","DOI":"10.2147\/DMSO.S268592","article-title":"The correlation of type 2 diabetes status with bone mineral density in middle-aged adults","volume":"13","author":"Yao","year":"2020","journal-title":"DMSO"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e0261361","DOI":"10.1371\/journal.pone.0261361","article-title":"Anthropometric, biochemical, and nutritional risk factors for osteoporosis in Korean adults based on a large cross-sectional study","volume":"16","author":"Yoo","year":"2021","journal-title":"PLoS ONE"},{"key":"B37","doi-asserted-by":"publisher","first-page":"9924410","DOI":"10.1155\/2021\/9924410","article-title":"The improving effect and safety of probiotic supplements on patients with osteoporosis and osteopenia: a systematic review and meta-analysis of 10 randomized controlled trials","volume":"2021","author":"Zeng","year":"2021","journal-title":"Evidence-Based Complementary Altern. Med."},{"key":"B38","doi-asserted-by":"publisher","first-page":"184","DOI":"10.3389\/fcell.2020.00184","article-title":"Characterization of dysregulated lncRNA-associated ceRNA network reveals novel lncRNAs with ceRNA activity as epigenetic diagnostic biomarkers for osteoporosis risk","volume":"8","author":"Zhang","year":"2020","journal-title":"Front. Cell Dev. Biol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"4270","DOI":"10.18632\/aging.204084","article-title":"Identification of combined biomarkers for predicting the risk of osteoporosis using machine learning","volume":"14","author":"Zheng","year":"2022","journal-title":"Aging"}],"container-title":["Frontiers in Aging"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fragi.2025.1511294\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T07:06:37Z","timestamp":1739257597000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fragi.2025.1511294\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,11]]},"references-count":39,"alternative-id":["10.3389\/fragi.2025.1511294"],"URL":"https:\/\/doi.org\/10.3389\/fragi.2025.1511294","relation":{},"ISSN":["2673-6217"],"issn-type":[{"type":"electronic","value":"2673-6217"}],"subject":[],"published":{"date-parts":[[2025,2,11]]},"article-number":"1511294"}}