A heart-healthy lifestyle might be the key to stronger bones—new research uncovers how cardiovascular health impacts bone mineral density across different age and health groups.

Study: Association between life’s essential 8 and bone mineral density among adults aged 20–59 years. Image Credit: April stock / Shutterstock

In a recent study published in the journal Scientific Reports, researchers examined the association between Life’s Essential 8 (LE8) scores and bone mineral density (BMD) in adults aged 20–59 years across diverse demographic and health subgroups.

Background

Osteoporosis, marked by reduced BMD, poses a significant health risk, particularly for individuals over 50, with over 30% of women and 20% of men at fracture risk. Shared risk factors like obesity, hypertension, and metabolic syndrome link osteoporosis and cardiovascular disease. Emerging evidence suggests cardiovascular health, measured by LE8, may influence BMD through mechanisms such as reduced inflammation, improved calcium metabolism, and hormonal regulation. Exploring this connection could enhance understanding of osteoporosis mechanisms and inform prevention and treatment strategies. Further research is essential to clarify the underlying pathways and develop targeted interventions.

About the Study

In the present study, data from the National Health and Nutrition Examination Survey (NHANES) 2011–2018, involving 39,156 participants, were analyzed. Exclusion criteria included participants younger than 20 or older than 59, postmenopausal women (a high-risk group for osteoporosis), individuals with chronic diseases affecting bone metabolism, those with incomplete data, and those with a history of fractures or osteoporosis. After exclusions, 2159 participants aged 20–59 years remained.

LE8, a cardiovascular health metric introduced by the American Heart Association, comprises four health behaviors (diet, physical activity, nicotine exposure, and sleep health) and four health factors (body mass index (BMI), blood lipids, blood glucose, and blood pressure). LE8 scores, ranging from 0 to 100, were calculated using validated methods. Dual-energy X-ray absorptiometry (DXA) measured BMD at multiple anatomical sites.

Covariates included demographic, lifestyle, and clinical factors such as age, race, smoking, alcohol consumption, vitamin D intake, and laboratory measurements. Analyses were performed using R software and adjusted for three models: unadjusted, adjusted for age/sex/race, and fully adjusted for socioeconomic, lifestyle, and clinical confounders. Statistical analyses, including weighted linear regression and subgroup analysis, assessed relationships between LE8 scores and BMD. Results were adjusted for multiple confounders, and significance was defined as P 

Study Results

A total of 2,159 participants were included in this study, with 52.15% being male and an average age of 36.61 ± 10.95 years. Participants in the high cardiovascular health (CVH) group were younger, predominantly female, and more likely to be non-Hispanic white with higher education levels and better socioeconomic status compared to the low CVH group. They also exhibited lower alcohol consumption and a higher prevalence of never smokers.

Although Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) levels were within the normal range, they were significantly higher in the high CVH group, while BMI was notably lower. An upward trend in lumbar spine and trunk BMD was observed as CVH scores increased. Additionally, the high CVH group had significantly fewer individuals with hypertension and diabetes (P 

Weighted multivariate linear regression demonstrated a positive association between LE8 scores and BMD at multiple anatomical sites. Fully adjusted models showed that LE8 scores were positively correlated with lumbar spine (β = 0.016, P P P P 

Subgroup analyses highlighted significant variations across age and BMI categories. Participants aged 20–34 showed the largest BMD increases, with every 10-point rise in LE8 scores associated with gains of 0.022 g/cm² in lumbar spine BMD, 0.012 g/cm² in thoracic spine BMD, 0.017 g/cm² in trunk BMD, and 0.013 g/cm² in total BMD (P 

In BMI-specific analyses, those in the normal BMI range (18.5–24.9) experienced greater BMD gains than underweight or overweight groups. For underweight and overweight individuals, LE8 scores showed no significant association with BMD. For each 10-point increase in LE8 scores, normal BMI individuals gained 0.020 g/cm² in lumbar spine BMD, 0.014 g/cm² in thoracic spine BMD, 0.021 g/cm² in trunk BMD, and 0.018 g/cm² in total BMD (P 

Gender-specific analysis revealed a positive association between LE8 scores and thoracic spine BMD among females (β = 0.011, P 

Conclusions

This study identifies a significant positive association between the LE8 score and BMD at various sites, with more potent effects observed in individuals with higher CVH. Younger individuals (20–34 years) and women, particularly for thoracic spine BMD, show more pronounced benefits, influenced by active bone metabolism and hormonal factors like estrogen. The authors noted that components of LE8—such as adherence to diets like DASH (high in calcium, low in sodium), physical activity, and smoking cessation—may enhance BMD by optimizing calcium absorption, reducing oxidative stress, and stabilizing hormone levels.

Healthy behaviors reflected in LE8, including balanced diets, physical activity, and optimal BMI, support both cardiovascular and bone health. These findings highlight LE8’s potential as a practical tool for assessing bone health and guiding personalized osteoporosis prevention strategies. However, the cross-sectional design limits causal inferences, and the exclusion of postmenopausal women restricts generalizability to this high-risk population. Future longitudinal studies are needed to confirm these findings.