The association of insulin resistance (IR), as indicated by the homeostasis model assessment of insulin resistance, with bone metabolism is yet to be clarified. We aimed to investigate the relationship of IR with bone mass by using the triglyceride-glucose (TyG) index as an alternative marker of IR. Data of 4810 non-diabetes individuals (2552 men aged ≥ 50 years and 2258 postmenopausal women) from the Korean National Health and Nutritional Examination Survey IV and V were analyzed. Bone mineral density (BMD) at the lumbar spine, femoral neck, total hip, and whole body were measured using dual-energy X-ray absorptiometry. After adjusting for confounding factors, there were inverse relationships of TyG index with femoral neck, total hip, and whole body BMD in men (β = − 0.085, P < 0.001 at femoral neck; β = − 0.046, P = 0.037 at total hip; β = − 0.098, P < 0.001 at whole body). However, in women, femoral neck and whole body BMD were negatively associated with the TyG index (β = − 0.071, P = 0.008 at femoral neck and β = − 0.065, P = 0.005 at whole body). The highest TyG index tertile exhibited reduced femoral neck BMD in both sexes (P = 0.003 in men and P = 0.013 in women) and reduced whole body BMD in men (P < 0.001) after adjusting for confounders. When the study subjects were divided into BMI (body mass index) < 23 kg/m² and ≥ 23 kg/m² groups, the TyG index was significantly associated with femoral neck BMD only in the women with BMI < 23 kg/m² (P = 0.009). We observed a significant association between the highest TyG index tertile and low bone mass at the femoral neck in women with BMI < 23 kg/m² (P = 0.003) that was not observed in women with BMI ≥ 23 kg/m² and men. In conclusion, IR evaluated using the TyG index was inversely associated with femoral neck BMD in non-diabetic men aged ≥ 50 years and postmenopausal women. The negative influence of IR on femoral neck BMD was robust in the women with BMI < 23 kg/m². This indicates a differential effect of IR on BMD according to skeletal site, sex, and BMI.

正如胰岛素抵抗的稳态模型评估所表明的那样，胰岛素抵抗 (IR) 与骨代谢的关系尚待阐明。我们旨在通过使用甘油三酯-葡萄糖 (TyG) 指数作为 IR 的替代标志物来研究 IR 与骨量的关系。分析了来自韩国国家健康和营养调查 IV 和 V 的 4810 名非糖尿病患者（2552 名 ≥ 50 岁男性和 2258 名绝经后女性）的数据。使用双能 X 射线骨密度仪测量腰椎、股骨颈、全髋和全身的骨矿物质密度 (BMD)。调整混杂因素后，男性 TyG 指数与股骨颈、全髋、全身 BMD 呈负相关（β  = − 0.085，P < 0.001 在股骨颈；β  = - 0.046, P  = 0.037，全髋；β  = - 0.098， 全身P < 0.001）。然而，在女性中，股骨颈和全身 BMD 与 TyG 指数呈负相关（股骨颈β  = - 0.071，P  = 0.008， 全身β  = - 0.065，P = 0.005）。在调整混杂因素后，最高的 TyG 指数三分位数表现出两种性别的股骨颈 BMD 降低（男性P  = 0.003，女性P  = 0.013）和男性全身 BMD 降低（P  < 0.001）。当研究对象被分为BMI（体重指数）<23 kg/m²组和≥ 23 kg/m ^{2组中，仅在 BMI < 23 kg/m 2}的女性中，TyG 指数与股骨颈骨密度显着相关（P  = 0.009）。^{我们观察到 BMI < 23 kg/m 2} ( P = 0.003)的女性股骨颈的最高 TyG 指数三分位数与低骨量之间存在显着关联，而 在 BMI ≥ 23 kg/m ²的女性和男性中未观察到这种关联. 总之，使用 TyG 指数评估的 IR 与 50 岁以上非糖尿病男性和绝经后女性的股骨颈 BMD 呈负相关。^{在 BMI < 23 kg/m 2}的女性中，IR 对股骨颈 BMD 的负面影响很大. 这表明 IR 根据骨骼部位、性别和 BMI 对 BMD 的不同影响。