Risk factors of high osteoporosis risk in subjects over 40 years in Mongolia

In Mongolia, osteoporosis screening is difficult because advanced scans are scarce. In 356 adults aged 40 years or older, stronger handgrip strength was associated with a lower OSTA-defined osteoporosis risk category in both men and women, whereas lifestyle factors were not. Adding handgrip testing could improve low-cost screening strategies.

Osteoporosis is a growing public health concern in Mongolia, where access to dual-energy X-ray absorptiometry (DXA) is limited. The Osteoporosis Self-Assessment Test (OSTA) provides a simple, low-cost alternative for identifying individuals at risk. This study aimed to examine factors associated with OSTA-defined osteoporosis risk categories among adults aged 40 years and older in Mongolia.

A cross-sectional study was conducted among 356 adults (200 men, 156 women) recruited from two urban health units. Sociodemographic characteristics, lifestyle factors, medical history, and handgrip strength were assessed through structured interviews and standardized measurements. OSTA scores were categorized into low, moderate, and high risk based on established sex-specific thresholds. Group differences in categorical variables were evaluated using chi-square tests. Logistic regression models were performed separately for men and women to identify factors independently associated with the combined moderate/high OSTA risk category.

Age, sex, educational level, comorbidities, and BMI were significantly associated with OSTA categories. Higher dominant handgrip strength was associated with lower odds of the combined moderate/high OSTA risk category in both men (OR 0.19, 95% CI 0.06-0.58) and women (OR 0.09, 95% CI 0.02-0.51). In contrast, lifestyle factors such as smoking, alcohol consumption, diet, and sedentary time were not independently associated with OSTA scores.

Several demographic and clinical factors were associated with OSTA risk categories in this low-resource setting. The strong association with handgrip strength suggests potential added value in integrating functional assessments into screening strategies. These findings support the development of scalable, low-cost approaches for osteoporosis risk stratification in Mongolia.