CLINICAL SIGNIFICANCE
- •The associations of lipid levels and of lipoprotein levels and size with hip fracture risk are uncertain.
- •In this study, HDL-c and LDL-c levels had significant non-linear associations with fracture risk.
- •VLDL number and size, and HDL particle size, were positively associated with risk.
- •Elevated lipid and lipoprotein levels are associated with hip fracture risk, suggesting an unanticipated protective benefit of lipid lowering medications in people with elevated LDL-c levels.
Abstract
Background
It is uncertain if lipids or lipoproteins are associated with osteoporotic fractures.
In this study, incident hip fracture risk according to conventional lipid levels and
lipoprotein levels and sizes was examined.
Methods
We followed 5832 participants aged ≥65 years from the Cardiovascular Health Study
for hip fracture for a mean of 13.5 (SD 5.7) years. Standard enzymatic methods were
used to determine lipid levels (HDL-c, LDL-c, triglycerides). Nuclear magnetic resonance
spectroscopy was used to measure lipoprotein fractions (VLDL-P, LDL-P, HDL-P) in a
subset of 1849 participants.
Results
We documented 755 incident hip fractures among women (1.19 fractures per 100 participant
years [95% CI, 1.04, 1.35]) and 197 among men (0.67 fractures per 100 participant
years [95% CI, 0.41, 1.10]) over an average follow-up. HDL-c and LDL-c levels had
statistically significant non-linear U-shaped relationships with hip fracture risk
(HDL-c, p=0.009; LDL-c, p=0.02). Triglyceride levels were not significantly associated
with hip fracture risk.
In fully adjusted conjoint models, higher VLDL-P concentration [HR per 1-standard
(SD) increment 1.47 (1.13, 1.91)] and size [HR per 1-SD increment 1.24 [1.05, 1.46])
and higher HDL-P size (HR per 1-SD increment 1.81 [1.25, 2.62]) were all associated
with higher hip fracture risk.
Conclusions
Lipids and lipoproteins are associated with hip fracture risk in older adults. The
associations are complex. Mechanistic studies are needed to understand these findings.
Keywords
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