Association between nutritional and inflammatory status and mortality outcomes in patients with osteoporosis and osteopenia

Osteoporosis, characterized by reduced bone density and microarchitecture deterioration, is a significant global health concern, particularly among aging populations and those with malnutrition. Osteoporotic fractures affect up to 50% of women and 22% of men, making the optimization of assessment metrics crucial. Systemic inflammation, often linked to malnutrition, plays a key role in bone loss. The Advanced Lung Cancer Inflammation Index (ALI), a marker of inflammation and nutrition, shows potential in predicting prognosis but has been insufficiently studied in osteoporosis. This study uses NHANES data to explore ALI’s association with mortality in osteoporosis, suggesting its potential as a prognostic tool. Data from the National Health and Nutrition Examination Survey (NHANES) (2007-2023) were analyzed retrospectively. Kaplan-Meier survival curves were used to depict survival data, and the relationship between ALI and mortality was assessed through multivariable Cox regression analysis and restricted cubic spline plots. Subgroup and mediation analyses were also conducted. The study included 4,525 osteoporosis patients with 938 all-cause and 223 cardiovascular deaths. A linear negative correlation between ALI and both all-cause and cardiovascular mortality was observed. Mediation analysis showed that 4.9% and 6.6% of the associations between osteoporosis/osteoporotic fractures and mortality risk were mediated by ALI. Subgroup analyses indicated that ALI predicts mortality across genders and activity levels. This study highlights a linear negative correlation between ALI and both all-cause and cardiovascular mortality in osteoporosis patients.