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Nonlinear association between physical activity and bone mineral density in adolescents

Pediatric Research (2026)Cite this article

Abstract

Background

This study aimed to examine the association between physical activity (PA) and bone mineral density (BMD) and to explore potential non-linear and threshold relationships in adolescents aged 12–19 years.

Methods

Data from the National Health and Nutrition Examination Survey 2005–2010 were used for this cross-sectional analysis. Statistical analyses included weighted multivariate linear regression, restricted cubic spline (RCS) analysis, threshold effect evaluation, and sensitivity analyses.

Results

After adjusting for covariates, adolescents with low PA had significantly lower BMD at both the lumbar spine and femoral neck compared to those with moderate activity levels (lumbar spine: β = −22.79, 95% CI: −37.86, −7.71, p = 0.005; femoral neck: β = −22.93, 95% CI: −43.66, −2.20, p = 0.032). High PA levels were not significantly associated with BMD (lumbar spine: p = 0.542; femoral neck: p = 0.226). RCS analyses revealed significant nonlinear associations between PA and BMD at both lumbar spine (p = 0.035) and femoral neck (p < 0.001). Threshold analysis showed that PA levels below 3500 MET-min/week were associated with higher BMD, but this association diminished as activity levels exceeded this threshold.

Conclusion

This study identified a nonlinear association between PA and BMD in adolescents, with evidence of a threshold effect around 3500 MET-min/week.

Impact

  • This study demonstrates a nonlinear association between physical activity and bone mineral density (BMD) in adolescents, indicating that increases in physical activity are beneficial to BMD only up to a certain level.

  • A threshold of approximately 3500 MET-min/week was identified, beyond which additional physical activity was not associated with further gains in BMD, suggesting the presence of an optimal range of activity for adolescent bone health.

  • Using data from adolescents in the nationally representative NHANES 2005–2010 dataset, the study applied weighted regression, spline modeling, and sensitivity analyses to ensure reliable, generalizable results.

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Fig. 1: Flowchart of study design.
Fig. 2: Dose–response relationships between physical activity (PA) and bone mineral density (BMD) among adolescents.
Fig. 3: The relationship between PA and BMD in different subgroups.

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Data availability

Publicly available datasets were analyzed in this study. Those data can be found here: www.cdc.gov/nchs/nhanes (accessed on 10 June 2025).

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Acknowledgements

We gratefully thank Jie Liu of the Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital for his contribution to the statistical support, study design consultations, and comments regarding the manuscript.

Funding

This work was supported by the Key Discipline of Jiaxing (Grant No. 2023-ZC-015) and the “Qimingxing” Talent Development Program of the First Hospital of Jiaxing (Talent ID: 2025-QMX-21).

Author information

Authors and Affiliations

  1. Department of Radiology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing, China

    Keyi Li

  2. Department of Intensive Care Unit, Tongxiang First People’s Hospital, Tongxiang, China

    Jianmin Qu

  3. The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China

    Chunhong Guo

  4. The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China

    Chunhong Guo

Authors
  1. Keyi Li
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  2. Jianmin Qu
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  3. Chunhong Guo
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Contributions

Keyi Li: Writing—review and editing, Writing—original draft, -visualization, validation, project administration, methodology, formal analysis, data curation, conceptualization. Jianmin Qu: Writing—review and editing, visualization, project administration, methodology, data curation. Chunhong Guo: Writing—review and editing, visualization, project administration, methodology, formal analysis, data curation, and conceptualization.

Corresponding author

Correspondence to Chunhong Guo.

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Competing interests

The authors declare no competing interests.

Informed consent

This study utilized publicly available data from the NHANES, which is conducted by the CDC. NHANES received approval from the National Center for Health Statistics (NCHS) Research Ethics Review Board, and informed consent was obtained from all participants or their guardians. No additional ethical approval was required for this secondary analysis, as the data were fully anonymized and de-identified prior to access.

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Li, K., Qu, J. & Guo, C. Nonlinear association between physical activity and bone mineral density in adolescents. Pediatr Res (2026). https://doi.org/10.1038/s41390-026-04876-x

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