# Association Between Calcium Level, Bone Mineral Density, and Hip Fracture: Analysis Based on NHANES Data

## TL;DR

This study uses NHANES data to explore how calcium levels, bone mineral density, and hip fractures are related, finding strong associations between calcium and BMD, and between BMD and hip fractures.

## Contribution

The study provides new insights into the statistical relationships between calcium, bone mineral density, and hip fractures using a large national dataset.

## Key findings

- Higher calcium intake is strongly associated with increased bone mineral density (p < 0.001).
- Increased bone mineral density is significantly linked to a reduced risk of hip fractures (p < 0.001).
- Mediation analysis suggests femur and total BMD levels mediate the relationship with hip fractures.

## Abstract

Introduction: The relationships between calcium, bone mineral density, and hip fracture have been studied for a long time, but there are still different opinions on the matter. The aim of this study was to decipher the relationship between these factors from National Health and Nutrition Examination Survey (NHANES) data. Methods: After we performed data cleaning for the obtained NHANES data, we used multiple imputation to obtain the complete data and conducted an analysis for different variables. First, by using multivariate linear regression models, we confirmed the association between calcium and bone mineral density, and then we confirmed the association between bone mineral density and hip fracture by using multivariate logistic regression models. A mediation analysis of these variables was performed. Results: The analysis in this study included data on 18,003 participants from the NHANES, and we were able to find a strong association between calcium and bone mineral density (p < 0.001). The association between bone mineral density and hip fracture was also significant (p < 0.001). One augmented gram of daily calcium intake was associated with a 0.04 unit increase in BMD level, and a one unit increase in BMD level could downgrade the occurrence of hip fracture for 5.4 times. The mediation analysis showed that the femur BMD level and total BMD level have a mediating relationship with hip fracture, and no clear relationship among calcium, BMD, and hip fracture could be established. Conclusions: Although it is difficult to draw strict conclusions from the mediation analysis in this study, we can observe a clear association between calcium and BMD as well as an association between BMD and hip fracture.