Anahita Houshiarrad ^* Danial Fotros ^* Mina Esmaili ^* Mohammad Hassan Sohouli ^* Marjan Ajami ^* Morteza Abdollahi ^* Motahare Hatami Marbini ^*

• Shahid Beheshti University of Medical Sciences, Tehran, Iran

Background: Osteoporosis is a chronic condition characterized by reduced bone strength and an ٢٧ elevated risk of fractures. The influence of diet and glucose metabolism on bone health and the ٢٨ development of osteoporosis has been an area of interest. This study aimed to investigate the ٢٩ potential association between dietary glycemic index (DGI), dietary glycemic load (DGL), dietary ٣٠ insulin index (DII), dietary insulin load (DIL), and the odds of osteoporosis among Iranian adults. ٣١ Methods: Data from 12,696 Iranian teachers (35-50 years) in a cross-sectional study on diet, ٣٢ nutrition, physical activity, and diseases were analyzed. The participants had no history of diabetes, ٣٣ cardiovascular diseases, stroke, thrombosis, or cancer and consumed between 800 and 4200 ٣٤ kcal/day. We estimated DGI, DGL, DII, and DIL from a validated semi-quantitative food-frequency questionnaire (FFQ). We also diagnosed osteoporosis using dual-energy X-ray ٣٦ absorptiometry.In the fully adjusted model, higher DGI and DGL were significantly associated with ٣٨ increased odds of osteoporosis (OR = 1.78 and 1.46 for the highest vs the lowest tertile; P trend ٣٩ <0.05). Nonetheless, no significant association was found between DII or DIL and osteoporosis ٤٠ prevalence. Moreover, higher DIL and DGL were associated with a higher intake of calorie-dense ٤١ /nutrient-poor foods and a lower intake of antioxidant-rich foods. ٤٢ Conclusion: Although our study showed that high DGI/DGL increased osteoporosis risk in Iranian ٤٣ teachers, no association was found between DII/DIL and osteoporosis prevalence. More research ٤٤ is needed to confirm these results and understand the mechanisms involved.