Firstly, albumin has antioxidant capacity (38), and low albumin levels reduce its antioxidant effect, leading to enhanced oxidative stress, which in turn triggers mitochondrial dysfunction and DNA damage (39, 40), contributes to bone marrow mesenchymal stem cell senescence (41, 42), affects osteogenesis, and increases the risk of osteoporosis; second, low albumin levels may promote osteoclasts through activation of NF-κB pathway differentiation and survival (43, 44), leading to osteolysis and further exacerbating osteoporosis. This evidence concerns the gene ALB and osteoporosis.