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. 2025 Jul 7;26(1):665.
doi: 10.1186/s12891-025-08838-y.

Association between serum phosphorus levels and pelvic bone mineral density in U.S. adults aged 18-59 years

Tao Jiang  1 , Yubo Pan  1 , Jianing Xu  1 , Junyong Ge  1 , Shiliang Ji  2 , Tian Li  3 , Yinquan Zhang  4
Affiliations

Association between serum phosphorus levels and pelvic bone mineral density in U.S. adults aged 18-59 years

Tao Jiang et al. BMC Musculoskelet Disord. .

Abstract

Background: Although the role of serum phosphorus in bone metabolism is well-established, its precise connection to bone density in different anatomical regions remains uncertain. The pelvis, a vital load-bearing structure crucial for movement and stability, has received limited attention because of its relationship with serum phosphorus. This study investigated the potential association between serum phosphorus levels and pelvic bone mineral density (BMD) in adults aged 18 to 59 years.

Methods: Using data from the 2015-2018 National Health and Nutrition Examination Surveys NHANES, we applied multivariable logistic regression models to investigate the association between serum phosphorus levels and pelvic BMD. The analysis was further refined using smoothed curves and generalized additive models.

Results: The analysis included a total of 5,589 adults. After adjusting for confounding variables, a negative association was observed between serum phosphorus levels and pelvic BMD. This inverse association was consistent in the subgroup analyses for females and Whites, however, this correlation was not found in males, Blacks, Mexican Americans, other Hispanics, or other racial groups.

Conclusion: Our findings indicated a notable inverse association between serum phosphorus levels and pelvic bone mineral density in females, while no significant association was observed in males.

Keywords: National health and nutrition examination surveys; Pelvic bone mineral density; Serum phosphorus levels.

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Conflict of interest statement

Declarations. Ethic approval and consent to participate: The NHANES protocols were approved by the Ethics Review Board of Third Affiliated Hospital of Naval Medical University, and written informed consent was obtained. Additionally, the study, in accordance with the Declaration of Helsinki, protocols received approval from the Third Affiliated Hospital of Naval Medical University’s research ethics committee at the Naval Medical University in Shanghai, China. Consent for publication: N/A. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable.

Figures

Fig. 1
Fig. 1
The selection flowchart of the participants
Fig. 2
Fig. 2
Association between serum phosphorus levels and pelvic bone mineral density. (A) Each black point represents a sample. (B) The solid red line represents the smooth curve fit between variables. The blue bands represent the 95% confidence intervals from the fit. Age, gender, race, educational level, BMI, family income-to-poverty ratio, smoking at least 100 cigarettes over the life period to the point of data collection, diabetes status, hypertension status, total calcium, blood urea nitrogen, total protein, and cholesterol were adjusted
Fig. 3
Fig. 3
Association between serum phosphorus levels and pelvic bone mineral density stratified by gender. Age, race, educational level, BMI, family income-to-poverty ratio, smoking at least 100 cigarettes over the life period to the point of data collection, diabetes status, hypertension status, total calcium, blood urea nitrogen, total protein, and cholesterol were adjusted
Fig. 4
Fig. 4
The association between serum phosphorus levels and pelvic bone mineral density stratified by race. Age, gender, educational level, BMI, family income-to-poverty ratio, smoking at least 100 cigarettes over the life period to the point of data collection, diabetes status, hypertension status, total calcium, blood urea nitrogen, total protein, and cholesterol were adjusted
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