Causal relationship between plasma metabolites and osteonecrosis: a large sample analysis based on genome-wide association study database and FinnGen database

• Three plasma metabolites (adenosine monophosphate to valine ratio, oxidized cysteinylglycine, and 3β,17β-androstenediol disulfate) show significant causal associations with osteonecrosis. • Adenosine monophosphate to valine ratio and 3β,17β-androstenediol disulfate are risk factors, while oxidized cysteinylglycine is a protective factor for osteonecrosis. • Mendelian randomization analysis using large-scale GWAS and FinnGen data provides robust evidence for these causal relationships. • These metabolites may serve as potential biomarkers for early diagnosis and therapeutic targets for osteonecrosis.