Socioeconomic status influences the relationship between residential green space and the risk of osteoporosis among rural adults: a large-scale population-based study

Objective Residential green space has been associated with a range of chronic health outcomes. However, its relationship with osteoporosis remains understudied. This study aimed to investigate the association between residential green space exposure and the prevalence of osteoporosis, and further to examine the combined effects of socioeconomic status (SES) on this relationship. Methods This study involved 6,544 participants from the Henan Rural Cohort study. Residential green space was measured via normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). SES was assessed by marital status, educational level, and average monthly income scores. Logistic regression and restricted cubic spline models were applied to explore the associations between residential green space exposure and osteoporosis risk. Results Higher levels of NDVI and EVI were significantly associated with lower odds of osteoporosis. Participants in the middle tertiles (T2) and highest tertiles (T3) of residential green space exposure exhibited lower odds of osteoporosis compared to those in the lowest tertile (T1) [ OR (95% CI ), EVI: T2, 1.01 (0.86, 1.18) and T3, 0.63 (0.54, 0.74); NDVI: T2, 0.73 (0.63, 0.86) and T3, 0.60 (0.51, 0.70)]. Higher SES was also associated with lower osteoporosis risk [ OR (95% CI ), T2, 0.89 (0.76, 1.03) and T3, 0.78 (0.64, 0.94)]. Moreover, participants with both high greenness exposure and high SES had a significantly lower risk of osteoporosis. Conclusion This study indicated that greater exposure to residential green space could be associated with a reduced risk of osteoporosis among rural adults, with SES potentially enhancing this relationship. These findings provide valuable insights for developing public health strategies to prevent and control osteoporosis in rural populations. Clinical trial registration http://www.chictr.org.cn/showproj.aspx?proj=11375 , Identifier ChiCTR-OOC-15006699