Impact of social determinants of health on mortality risk in older adults with osteopenia or osteoporosis

Osteopenia and osteoporosis are prevalent bone disorders among older adults that impose substantial health and economic burdens. This study aimed to explore the associations between social determinants of health (SDOH) and mortality risk in this vulnerable population. We analyzed data of 3087 older adults (mean age 70.62 years, 66.95 % women) from the 2005-2010, 2013-2014, and 2017-2018 cycles of National Health and Nutrition Examination Survey. SDOH were quantified using an 8-item composite score and categorized into four groups: 7-8 (reference) group, 5-6 group, 3-4 group, and 0-2 group. The primary and secondary outcomes were all-cause and cardiovascular disease (CVD) mortality, respectively. Mortality risks were assessed using Cox proportional hazards models, restricted cubic splines, and stratified analyses. During a median follow-up period of 79 months, 913 (25.11 %) death occurred, including 302 CVD mortality. Compared to the reference group, multivariable-adjusted hazard ratios (95 % confidence intervals) for the SDOH 5-6 group, 3-4 group, and 0-2 group were 1.38 (1.18-1.61, P < 0.001), 1.92 (1.48-2.50, P < 0.001), and 2.11 (1.41-3.14, P < 0.001), respectively, for all-cause mortality, and 1.58 (1.14-2.20, P = 0.006), 2.29 (1.54-3.39, P < 0.001), and 2.57 (1.45-4.55, P = 0.001), respectively, for CVD mortality. Restricted cubic spline curves demonstrated a significant inverse linear relationship between SDOH score and mortality risk. Results remained consistent across sex, race/ethnicity, physical activity, and body mass index subgroups. Adverse SDOH demonstrates a strong, graded association with elevated mortality risk in older adults with osteopenia or osteoporosis. Systematic SDOH screening and targeted interventions may reduce mortality disparities in this population.