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Osteoporosis is a known risk factor for fractures, but new research published in Menopause suggested it may also provide insight into broader health outcomes.

In an observational study, women who met criteria for osteoporosis based on femoral bone mineral density (BMD) measurements had a 47% increased risk for all-cause mortality after adjustment for demographic and clinical factors (hazard ratio [HR], 1.47; 95% CI, 1.16-1.86). Researchers also found that low BMD across four femoral regions — total femur, femoral neck, trochanter, and intertrochanteric — were associated with mortality risk.

The association was strongest in total femur BMD ranges of 0.46-0.71 g/cm² and trochanter BMD ranges of 0.33-0.54 g/cm².

“The study reveals a significant inverse correlation between femoral BMD and mortality, providing novel epidemiological evidence for BMD as a prognostic biomarker of systemic health,” the authors wrote.

The research adds to earlier literature linking osteoporosis with all-cause mortality.

The findings “highlight the need to assess overall health including frailty, sarcopenia, nutritional status, and fall risk in this patient population,” said Ananya Jhaveri, MD, an assistant professor in the Division of Endocrinology, Metabolism and Nutrition at Rutgers Health Robert Wood Johnson Medical School in New Brunswick, New Jersey, who was not associated with the study.

The study included nearly 3000 postmenopausal women participating in the National Health and Nutrition Examination Survey between 2005 and 2018. BMD measurements were taken using DEXA and participants were followed for a mean of 7.26 years.

Women with osteoporosis tended to be older, non-Hispanic White, and unmarried, with a lower BMI and higher rates of depression and osteoporotic fractures than their counterparts. Mortality rates also differed substantially: 27.7% in women with osteoporosis vs 11% in those without.

But since the association remained significant after adjustment for these factors, the findings suggest that low femoral BMD may independently reflect broader physiologic decline, according to the authors.

BMD outperformed BMI as a predictor of mortality, a finding that didn’t surprise Jhaveri.

“Patients with sarcopenia and low muscle mass may have normal BMI due to high fat mass but sarcopenic patients are likely to have overall poor health,” Jhaveri said. “Additionally, BMI does not account for physical activity, mechanical loading, calcium and vitamin D intake, all of which can affect BMD.”

The researchers found no significant association between fractures and mortality risk. But self-reported fracture data may have led to misclassification, and women who died shortly after a fracture could have been missed, Jhaveri said.

Jhaveri cautioned against interpreting the findings as evidence that increasing BMD will necessarily reduce mortality risk.

“Prior studies have not consistently shown improvement in mortality with osteoporosis treatments and improved BMD, so it would be difficult to make treatment decisions based on this data on mortality alone,” Jhaveri said.

The study was funded by the Natural Science Foundation of Jiangxi Province, Graduate research and practice innovation project of Qinghai University, and Jiangxi Ganpo Outstanding Talent Support Program-High level overseas Talent Project. None of the sources in this article reported disclosures.

Brittany Vargas is a journalist covering medicine, mental health, and wellness.