Associations between controlling nutritional status (CONUT) scores, osteopenia, and osteoporosis during menopausal transition: a NHANES study

BACKGROUND: Osteopenia and osteoporosis commonly affect women during the menopausal transition. The controlling nutritional status (CONUT) score, a marker of nutritional health, has been linked to various clinical outcomes, but its relationship with bone health in menopause remains unclear. This study examined associations between CONUT scores and osteopenia and osteoporosis in menopausal women. METHODS: Data from 1188 women aged 45-55 years in the 2005-2010 National Health and Nutrition Examination Survey (NHANES) were analyzed, representing 19.5 million U.S. women. Bone mineral density (BMD) at the femur sites was assessed using dual-energy X-ray absorptiometry (DEXA), and T-scores defined osteopenia and osteoporosis. CONUT scores were derived from serum albumin, total cholesterol, and lymphocyte count. Logistic regression evaluated associations between CONUT scores and bone health outcomes, adjusting for confounders. Analyses were stratified by body mass index (BMI > 25 vs. ≤ 25 kg/m2). RESULTS: Women with higher CONUT scores (≥2) had significantly greater odds of osteopenia (adjusted odds ratio [aOR] = 1.82; 95% CI: 1.06-3.13; P = .031). No significant association was observed between CONUT scores and osteoporosis (P = .091). In BMI-stratified analysis, the association between high CONUT scores and osteopenia was stronger among women with BMI > 25 kg/m2 (aOR = 2.66; 95% CI: 1.41-5.01; P = .003). CONCLUSIONS: Poor nutritional status, as reflected by higher CONUT scores, is associated with higher likelihood of osteopenia in women undergoing menopausal transition, especially those with higher BMI. Key messages What is already known on this topic: Osteopenia and osteoporosis occur commonly in women undergoing menopausal transition. Use of controlling nutritional status (CONUT) scores to assess nutritional health, has been associated with various health outcomes, but the CONUT role in bone health during menopause has not been explored. What this study adds: This study examined the association between nutritional status, as assessed by the CONUT score, and bone health in women during the menopausal transition. The results demonstrated that poorer nutritional status was significantly associated with a higher likelihood of osteopenia, particularly among individuals with higher BMI. How this study might affect research, practice, or policy: These findings suggest that attention to nutritional status may contribute to strategies aimed at preventing early bone deterioration.