Higher high-density lipoprotein cholesterol levels increased vertebral osteoporotic fracture, but reduced hip fracture in men based on the National Health Insurance Service-National Health Screening Cohort

Jae-Woo Lee; Jeongsook Kim; Yonghwan Kim; Ye-Seul Kim; Joungyoun Kim; Hee-Taik Kang

doi:10.1016/j.spinee.2024.05.003

Higher high-density lipoprotein cholesterol levels increased vertebral osteoporotic fracture, but reduced hip fracture in men based on the National Health Insurance Service-National Health Screening Cohort

Spine J. 2024 May 13:S1529-9430(24)00238-9. doi: 10.1016/j.spinee.2024.05.003. Online ahead of print.

Authors

Jae-Woo Lee¹, Jeongsook Kim², Yonghwan Kim³, Ye-Seul Kim³, Joungyoun Kim⁴, Hee-Taik Kang⁵

Affiliations

¹ Department of Family Medicine, Chungbuk National University Hospital, Chungdae-ro, Seowon-gu, Cheongju, Chungcheongbuk-do 28644, Republic of Korea; Department of Family Medicine, Chungbuk National University College of Medicine, Chungdae-ro, Seowon-gu, Cheongju, Chungcheongbuk-do 28644, Republic of Korea.
² Department of Biostatistics and Computing, Yonsei University Graduate School, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
³ Department of Family Medicine, Chungbuk National University Hospital, Chungdae-ro, Seowon-gu, Cheongju, Chungcheongbuk-do 28644, Republic of Korea.
⁴ Department of Artificial Intelligence, University of Seoul, 163 Seoulsiripdae-ro, Dongdaemun-gu, Seoul 02504, Republic of Korea.
⁵ Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea; Institute for Innovation in Digital Healthcare, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea. Electronic address: familydoctor@yuhs.ac.

PMID: 38750822
DOI: 10.1016/j.spinee.2024.05.003

Abstract

Background context: Lipids are currently known to play an important role in bone metabolism.

Purpose: This study aimed to investigate the effect of high-density lipoprotein cholesterol (HDL-C) on osteoporotic fractures beyond its beneficial effects on the cardiovascular system.

Study design/setting: This was a retrospective, observational study that used data from the National Health Insurance Service-Health Screening cohort database.

Patient sample: This study included 318,237 participants who were 50 years or older and with HDL-C levels of 10 to 200 mg/dL.

Outcomes measures: Physiologic measure-Diagnosis of osteoporotic fracture during the follow-up period.

Methods: The study participants were categorized into four quartiles according to baseline HDL-C levels. The Cox proportional hazards model was used to assess osteoporotic fracture risk according to HDL-C levels.

Results: After full adjustment and with the Q1 group as the reference group, estimates of hazard ratios (HRs; 95% confidence intervals [CIs]) for any osteoporotic fracture in men were 1.03 (0.94-1.12), 1.02 (0.93-1.11), and 1.07 (0.98-1.18) for the Q2, Q3, and Q4 groups, respectively. After classifying osteoporotic fractures according to the body location, the fully adjusted HRs for vertebral and hip fractures in the men's Q4 groups were 1.16 (1.02-1.31) and 0.74 (0.57-0.96), respectively. In women, fully adjusted HRs (95% CIs) of the female Q4 group for any osteoporotic, vertebral, and hip fractures were 1.03 (0.95-1.11), 0.96 (0.86-1.07), and 1.06 (0.80-1.41), respectively.

Conclusion: In this study, HDL-C levels were positively associated with vertebral fractures in both men and women but inversely related to hip fractures in men. Therefore, monitoring the lipid profiles of patients with osteoporosis may be beneficial for the prevention of osteoporotic fractures.

Keywords: Bone metabolism; High density lipoprotein; Lipid; National Health Insurance Service; Osteoporosis; Osteoporotic fracture.