| Objective To explore the relationship between the ratio of serum uric acid (sUA) to high-density lipoprotein cholesterol (HDL-C), referred to as the UHR, and osteoporosis in the elderly using data from the National Health and Nutrition Examination Survey (NHANES). Methods We selected 5534 participants aged 50 years and older from the NHANES cross-sectional study. We assessed the relationship between UHR and osteoporosis using weighted linear regression, Chi-square tests, logistic regression models, subgroup analysis, restricted cubic spline (RCS) analysis, and receiver operating characteristic (ROC) curve analysis. Results The UHR in patients with osteoporosis (10.02±5.22) was significantly lower than in those without osteoporosis (11.81±5.18, P < 0.001). Patients in the osteoporosis group was older (average age 73.6±8.61 years), predominantly female (79.15%), and had a lower body mass index (BMI) (64.17% BMI < 25). Significant differences were observed in terms of race, marital status, income, alcohol consumption, smoking, and hypertension status. A lower UHR was significantly associated with a higher incidence of osteoporosis (OR: 0.53, 95% CI: 0.35-0.78, P=0.002). Subgroup analysis showed consistent associations across different demographic characteristics. RCS analysis indicated a significant non-linear relationship (overall P=0.007, non-linearity P=0.005). ROC analysis suggested that UHR had better discriminative ability to distinguish osteoporosis compared to serum uric acid (AUC=0.595) and HDL-C (AUC=0.602), with UHR having an AUC of 0.624. Conclusion A significant association is found between lower UHR and higher incidence of osteoporosis in the elderly. These findings suggest that UHR may serve as a useful biomarker for assessing the risk of osteoporosis in this population. |