Introduction:
Osteoporosis patients undergoing surgery often have significant bleeding, which is closely related to coagulation function. This study aimed to assess the correlation between bone turnover markers (BTMs), bone mineral density (BMD), and coagulation biomarkers.

Material and methods:
Cases meeting the inclusion criteria were included from our center from January 2020 to December 2021. The relationships between coagulation biomarkers, BTMs, and BMD were investigated by Spearman correlation analysis and canonical correlation analysis (CCA). Consequently, age, bone mass stage, 25-hydroxyvitamin D (25-(OH)D), and BMD were included as independent variables in the logistic regression model. Furthermore, the international normalized ratio (INR), fibrinogen, platelets, and D-dimer levels were set as dependent variables in the regression analysis. Finally, multivariable regressions were conducted to adjust for differences in demographics and comorbidities among groups.

Results:
A total of 306 patients were included in the study. Significant differences were observed in prothrombin time, fibrinogen, INR, D-dimer, and platelets (p < 0.05). D-dimer exhibited the most significant positive association with age and the most pronounced negative correlation with the BMD of Ward’s triangle (r = 0.322, p < 0.001; r = –0.298, p < 0.001; respectively). 25-(OH)D and calcium were related to coagulation biomarkers. Multivariate analysis demonstrated that age was positively associated with D-dimer levels (odd ratio [OR] = 1.046, p = 0.007), while the BMD of Ward’s triangle was negatively related to D-dimer levels (OR = 0.004, p = 0.0017).

Conclusions:
For the Chinese population aged 50 and above, attention should be paid to alterations in coagulation biomarkers.