Associations of Insulin Resistance Indices and Atherogenic Lipid Parameters with Bone Mineral Density and Fragility Fracture History in Men Aged 50 Years and Older and Postmenopausal Women with Osteopenia or Osteoporosis

Abstract

Objective: Insulin resistance (IR) and atherogenic dyslipidemia (AD) are metabolic disturbances strongly associated with cardiometabolic diseases. In recent years, the evidence regarding the associations of IR and AD with skeletal measures and fracture outcomes in older individuals has remained limited and inconsistent. The aim of this study was to evaluate the relationships of insulin resistance indices and atherogenic lipid parameters with bone mineral density measurements and fragility fracture history in men aged 50 years and older and postmenopausal women in the presence of osteopenia or osteoporosis.Materials and Methods: This single-center retrospective cross-sectional study was conducted at Kayseri City Hospital, Türkiye, between January 2025 and December 2025, and included men aged ≥50 years and postmenopausal women who underwent bone mineral density (BMD) measurement for screening purposes. Given the limited reliability of fasting insulin levels in older adults, insulin resistance was evaluated through the Metabolic Score For Insulin Resistance (METS-IR) and the triglyceride-glucose (TyG) index in place of HOMA-IR. Atherogenic dyslipidemia was characterized using triglyceride concentrations, HDL-C, LDL-C, total cholesterol, non-HDL-C, and the non-HDL-C/HDL-C ratio. Dyslipidemia was defined by elevated triglyceride concentrations, reduced HDL-C, or increased LDL-C, according to established thresholds. Fracture history was determined using clinical records and patient self-reports.Results:A total of 150 patients diagnosed with osteopenia or osteoporosis were included in the final analyses; 72.7% were female, and 37.3% had a history of fragility fracture (FF). FF was not associated with hypertension or dyslipidemia; however, it was observed more frequently among participants with a prior history of cerebrovascular events. The TyG index showed no significant association with bone-related parameters, whereas METS-IR demonstrated a significant positive association with femoral T-score and femoral BMD. In addition, individuals with higher METS-IR values also had higher non-HDL cholesterol levels and NHHR. Age was identified as an independent determinant of FF history.Conclusion: In this selected population of men aged 50 years and older and postmenopausal women with osteopenia or osteoporosis, age remained the primary correlate of fragility fracture history. While age remains the primary determinant of fracture risk, METS-IR showed a significant positive association with femoral BMD and femoral T-score in correlation analyses, whereas no comparable association was observed with respect to the TyG. Taken together, these observations highlight that the effects of metabolic disturbances on bone health should not be interpreted as uniform risk factors but rather evaluated within the context of age, body composition, and overall metabolic status.