Lingna Fang,1 Zhiqin Zhang,2 Dawei He,3 Yanming Hao,4 Yan Gao,4 Rongzhu Lu,5 Chong Li4,6 

1Department of Geriatrics, Kunshan Hospital Affiliated of Jiangsu University, Kunshan, 215300, People’s Republic of China; 2Biobank, Kunshan Hospital Affiliated of Jiangsu University, Kunshan, 215300, People’s Republic of China; 3Central Laboratory, Kunshan Hospital Affiliated of Jiangsu University, Kunshan, 215300, People’s Republic of China; 4Department of Orthopaedics, Kunshan Hospital Affiliated of Jiangsu University, Kunshan, 215300, People’s Republic of China; 5Department of Preventive Medicine and Health Inspection, Jiangsu University, Zhenjiang, 310030, People’s Republic of China; 6Department of orthopaedics, Atushi People’s Hospital, Atushi, 845350, People’s Republic of China

Correspondence: Chong Li, department of orthopaedics, Kunshan Hospital Affiliated of Jiangsu University Kunshan, Kunshan, 215300, People’s Republic of China, Tel +8618906263110, Fax +86512 57501112, Email f30907988@163.com

Background: The aim of this study was to examine the impact of a sulfur-containing diet and a CTH polymorphism (G1208T; rs1021737) on bone density.
Methods: A total of 200 Uyghur residents aged over 50 from Xinjiang, China, were recruited for this study. Fasting blood samples were collected from the participants to measure serum hydrogen sulfide (H2S) levels and perform CTH polymorphism sequencing. Dietary sulfur intake was assessed using a food frequency questionnaire and categorized into animal protein-derived and non-animal protein-derived sources. Skeletal health of the calcaneus was evaluated using quantitative ultrasound scanning.
Results: The study included a total of 200 participants, comprising 81 males and 119 females. Participants were stratified based on osteopenia status, with a T-score ≥ − 1.0 indicating normal bone density and a T-score < − 1.0 indicating osteopenia. Individuals in the osteopenia group exhibited significantly lower bone density markers, including broadband ultrasound attenuation (BUA) and speed of sound (SOS), as well as lower total weekly dietary sulfur intake and weekly dietary sulfur intake from animal protein. Additionally, they had significantly higher serum H2S levels compared to participants with normal bone density. However, no differences in CTH genotype were observed between the normal bone density group and the osteopenia group. Participants were further categorized into tertiles (Q1 to Q3) based on weekly dietary sulfur intake from animal protein. Compared to the Q1 group, the Q3 group showed significantly higher T-scores and BUA values. Binary logistic regression analysis revealed that, compared to the group with high weekly dietary sulfur intake from animal protein, the low and middle intake groups had 3.252 times and 4.330 times higher risks of osteopenia, respectively.
Conclusion: Dietary sulfur intake from animal protein may exert a protective effect on bone density.

Keywords: sulfur, hydrogen sulfide, CTH, gene polymorphism, bone mineral density