Association of low-carbohydrate-diet score and osteoporotic fractures: National Health and Nutrition Examination Survey

Front Public Health. 2025 Oct 8:13:1668024. doi: 10.3389/fpubh.2025.1668024. eCollection 2025.

Abstract

Background: Osteoporotic fractures represent a significant public health concern on a global scale. There is currently a lack of research on the association between low-carbohydrate-diet score and Osteoporotic fractures risk.

Methods: A cross-sectional analysis was performed involving 13,025 participants from the National Health and Nutrition Examination Survey, utilizing data collected from the years 2005 to 2010, 2013 to 2014, and 2017 to 2018. Logistic regression analyses were used to explore the association between the Low-Carbohydrate Diet score and Osteoporotic fractures risk. Restricted cubic spline analysis was conducted to evaluate the linearity or nonlinearity of the association. Subgroup and interaction analyses were also performed.

Results: Following the adjustment for confounding variables, a positive correlation was identified between elevated Low-Carbohydrate Diet scores and an increased risk of Osteoporotic fractures. Specifically, a one-point increment in Low-Carbohydrate Diet score corresponded to a 1.13% rise in Osteoporotic fractures risk (OR = 1.0113, 95% CI: 1.0015-1.0212, p = 0.0240). The risk of Osteoporotic fractures among individuals in the highest Low-Carbohydrate Diet quartile was significantly greater compared to those in the lowest quartile (OR = 1.2248, 95% CI: 1.0212-1.4388, p = 0.0295). The Restricted cubic spline analyses revealed a linear relationship between Low-Carbohydrate Diet score and Osteoporotic fractures risk. Subgroup and interaction analyses demonstrated that age, alcohol consumption, and hypertension had moderating effects on this association.

Conclusion: Higher Low-Carbohydrate Diet scores were associated with a greater risk of Osteoporotic fractures, offering a new perspective on the link between dietary patterns and fracture risk.

Keywords: National Health and Nutrition Examination Survey; adults and older adults; low-carbohydrate diet; macronutrients; osteoporotic fractures.

MeSH terms

  • Adult
  • Aged
  • Cross-Sectional Studies
  • Diet, Carbohydrate-Restricted* / adverse effects
  • Diet, Carbohydrate-Restricted* / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Osteoporotic Fractures* / epidemiology
  • Risk Factors
  • United States / epidemiology