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 (ie, high-density lipoprotein-cholesterol [HDL-c],
low-density lipoprotein-cholesterol [LDL-c], and triglycerides). Nuclear magnetic
resonance spectroscopy was used to measure lipoprotein fractions (ie, very-low-density
lipoprotein-particle [VLDL-P], low-density lipoprotein-particle [LDL-P], high-density
lipoprotein-particle [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% confidence interval, 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 nonlinear U-shaped relationships with hip fracture
risk (HDL-c, P = .009; LDL-c, P = .02). Triglyceride levels were not significantly associated with hip fracture risk.
In fully adjusted conjoint models, higher VLDL-P concentration (hazard ratio [HR]
per 1 standard deviation [SD] increment 1.47 [1.13, 1.91] and size [HR per 1 SD increment
1.24 [1.05, 1.46]) and higher high-density lipoprotein particle 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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Article Info
Publication History
Published online: June 06, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: This research was supported by contracts HHSN268201200036C , HHSN268200800007C , HHSN268201800001C , N01HC55222 , N01HC85079 , N01HC85080 , N01HC85081 , N01HC85082 , N01HC85083 , N01HC85086 , 75N92021D00006 , and grants U01HL080295 and U01HL130114 from the National Heart, Lung, and Blood Institute (NHLBI) , with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS) . Additional support was provided by R01AG023629 from the National Institute on Aging (NIA) . A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
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