300 Section - Association of Serum Ferritin with Osteosarcopenic Obesity in Korean Population over 50 years Using Korea National Health and Nutrition Examination Survey

This study aimed to examine the association between serum ferritin levels and osteosarcopenic obesity (OSO)—a condition characterized by the coexistence of osteopenia/osteoporosis, sarcopenia, and obesity—in Korean adults aged 50 years and older. Because ferritin reflects both iron storage and chronic inflammation, understanding its relationship with age-related adverse body composition may provide insight into OSO pathophysiology.

Design: We conducted a cross-sectional analysis using data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2008–2011. Participants aged ≥50 years who underwent dual-energy X-ray absorptiometry (DXA) were included, while those with malignancy, cardiovascular disease, or stroke were excluded. Serum ferritin levels were categorized into sex-specific tertiles. Osteopenia/osteoporosis, low muscle mass, and obesity were defined using DXA-derived criteria. Multivariate logistic regression, adjusted for age, comorbidities, lifestyle factors, and laboratory markers, was performed to assess the association between ferritin tertiles and the number of abnormal body composition components. Sampling weights were applied to account for the complex survey design.

Results: A total of 6,941 participants (3,961 women; 2,980 men) were analyzed. Women exhibited lower muscle mass, lower bone mineral density, and lower ferritin levels compared with men. In women, higher ferritin tertiles were significantly associated with an increased likelihood of having multiple adverse body composition components. After full adjustment, the association remained significant for having two abnormal components, while the association with full OSO showed no statistical significance. In contrast, no significant associations were observed across ferritin tertiles in men.

Conclusion: Elevated serum ferritin levels were associated with a higher risk of adverse body composition patterns related to OSO in older Korean women but not in men. These findings suggest sex-specific interactions between iron metabolism, inflammation, and age-related changes in muscle, fat, and bone. Further longitudinal studies are warranted to clarify causal mechanisms, identify clinically meaningful ferritin thresholds, and refine diagnostic criteria for OSO.