OBJECTIVE: To explore the predictive value of the blood uric acid/creatinine ratio (SUA/Cr) and the Osteoporosis Self-Assessment Tool for Asians (OSTA) for osteoporosis (OP) in middle-aged, older, and elderly adult Tibetan populations in Xizang. METHODS: A total of 1058 middle-aged and older adult ethnic Tibetans who underwent physical examination in Xizang between June 2020 and December 2023 were selected for the study. Fasting venous blood samples were collected for laboratory analysis. The bone mineral density (BMD) of the radius of the participants was measured using dual-energy X-ray absorptiometry. Based on the BMD measurement results and OP diagnostic criteria, participants were divided into the OP group ( RESULTS: 1) The OP prevalence among the middle-aged and older adult Tibetan populations was 28.3% (299 people), including 209 females (69.9%) and 90 males (30.1%). Significant differences between the two groups were found in terms of age (OP group: 62 [54, 69] vs non-OP group: 56 [51, 62]), SUA/Cr (OP group: 6.86 [5.06, 10.23] vs non-OP group: 5.36 [4.36, 6.52]), and OSTA (OP group: [－1.27 ± 3.06] vs non-OP group: [1.25 ± 2.68]) ( CONCLUSION: The predictive performance of SUA/Cr and OSTA for OP varies across different sex and age groups in the Tibetan population. Both SUA/Cr and OSTA can be used to predict OP in middle-aged and older adult Tibetan populations, with the combined use of SUA/Cr and OSTA providing better predictive performance.