Association between the Triglyceride-glucose index and fragility fractures among US adults: insights from NHANES

The triglyceride-glucose (TyG) index, a recognized marker for insulin resistance, holds potential implications for skeletal health. However, its relationship with fragility fractures remains uncertain. We aimed to elucidate the association between the TyG index and fragility fractures in the general US population. Cross-sectional data of 25,082 participants were obtained from the National Health and Nutrition Examination Survey. The association between the TyG index and fragility fractures was investigated using univariate and weighted multivariate logistic regression as well as restricted cubic spline (RCS) regression models. The least absolute shrinkage and selection operator regression with ten-fold cross-validation was employed to identify key variables, leading to the development of a nomogram model. Calibration and receiver operating characteristic curves were utilized to evaluate the model's validity. The overall prevalence of fragility fractures among participants was 1.10%. After adjusting for confounders, the TyG index exhibited a robust association with the risk of fragility fractures (odds ratio, 1.94; 95% confidence interval, 1.31–2.88; P < 0.001). RCS regression demonstrated a positive linear relationship between the TyG index and fragility fractures. The predictive nomogram, incorporating the TyG index and other clinical factors, demonstrated favorable predictive performance (consistency index = 0.901). Elevated TyG index levels were significantly correlated with the risk of fragility fractures in the general US population. These findings suggest that the TyG index may serve as a predictive marker for fragility fractures, underscoring the importance of early intervention and improved fracture risk assessment tools in clinical practice.