Hemoglobin–Albumin–Lymphocyte–Platelet (HALP) score as a low-cost adjunct for osteoporosis risk stratification in primary care

Background: This study aimed to evaluate the hemoglobin, albumin, lymphocyte, and platelet (HALP) score as an exploratory adjunctive marker associated with reduced bone density, particularly in resource-limited settings. Methods: This cross-sectional study was conducted between October 2022 and October 2023 at the Physical Therapy and Rehabilitation Hospital in Trabzon, Türkiye. This study included 267 patients who had not been previously diagnosed with osteopenia or osteoporosis and had undergone a dual-energy X-ray absorptiometry (DEXA) scan within the previous year. The participants were categorized into the normal, osteopenic, and osteoporotic groups according to their DEXA results. Statistical analysis included receiver operating characteristic (ROC) curve assessment, sensitivity and specificity calculations, and multiple logistic regression analysis to evaluate the discriminative performance of the HALP score and its adjusted association with reduced bone density. Results: Patients with reduced bone density (osteopenia or osteoporosis) had substantially lower HALP scores than those with a normal bone density. The area under the curve (AUC) for the HALP score was 0.625, indicating a limited discriminative ability. The HALP score exhibited a sensitivity of 65.36% and a specificity of 55.26% for identifying reduced bone density. In multivariable analysis, higher HALP remained associated with lower odds of osteopenia/osteoporosis after adjustment (OR = 0.757, 95% CI 0.624–0.917, p = 0.004). Conclusion: Given its limited discriminative ability, HALP should not be interpreted as a stand-alone screening test. At most, it may represent a low-cost exploratory adjunctive signal that could help support consideration of confirmatory DEXA in resource-limited settings, pending external validation. Trial registration: Not applicable. © The Author(s) 2026.