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Article History

Received: 30 May 2026

Accepted: 13 July 2026

First Online: 31 July 2026

Declarations

Competing interests: The authors declare no competing interests.

Ethics approval and consent to participate: This study used only de-identified data from publicly released cohort releases (OsteoLaus, NHANES Bone Health Subset, SOF) and an external MrOS public-use subset; the secondary-analysis protocol was reviewed by the Research Ethics Committee of The First Affiliated Hospital of Yangtze University (Reference No. 2023-K-097) and granted a waiver of informed consent on the basis that all source records had already been de-identified by the originating data custodians. The original parent cohorts had their own IRB approvals from the respective institutions: OsteoLaus from the Ethics Committee of the Canton of Vaud (Switzerland), NHANES from the National Center for Health Statistics Research Ethics Review Board, and SOF and MrOS from the participating United States academic medical centres. No identifiable patient information was accessed by the authors at any stage, all simulations of cross-site federation were carried out on local copies of the released files, and the procedures complied with the principles of the Declaration of Helsinki.

Consent for publication: All authors have reviewed the manuscript and consent to its publication. No identifiable information regarding participants has been included.