Association of Plasma High-Density Lipoprotein Cholesterol Level With Risk of Fractures in Healthy Older Adults

Association of nuclear magnetic resonance-based metabolomics with bone health in the UK Biobank

OBJECTIVES

The study aimed to explore associations of metabolomic data based on nuclear magnetic resonance (NMR) with the risk of fractures and bone mineral density (BMD).

METHODS

We included 69,963 participants without fractures at baseline in the UK Biobank. Cox proportional hazard models were used to estimate the associations of metabolomic biomarkers measured by NMR technology with the risk of all fractures and hip fracture. We used principal component analysis (PCA) to obtain uncorrelated principal components (PC), which were further used to estimate the associations of each PC with BMD, all fractures, and hip fracture separately.

RESULTS

During a median follow-up of 12.6 years, 3840 incidents of all fractures and 666 incidents of hip fracture were documented. Ninety-four of the 143 metabolomic biomarkers were significantly associated with incident all fractures, and 81 were significantly associated with incident hip fracture. The very low-density lipoprotein (VLDL) subclasses in different lipid constituents were associated with increased BMD at multiple sites, whereas high-density lipoprotein (HDL) subclasses were associated with decreased BMD. Higher concentrations of small (HR per SD increment: 0.92; 95 % CI: 0.88-0.97), medium (HR per SD increment: 0.91; 95 % CI: 0.88-0.94), and large (HR per SD increment: 0.93; 95 % CI: 0.90-0.96) low-density lipoprotein (LDL) particles were associated with a lower risk of all fractures. Similarly, higher VLDL subclasses (excluding very small VLDL particles) were associated with a lower risk of all fractures. Besides, higher levels of lipid constituents (including total lipids, cholesteryl esters, cholesterol, and free cholesterol) of very large and large HDL were associated with an increased risk of all fractures. PC1 (mainly contributed by lipid subclasses of LDL and VLDL), which explained the most variance of individual biomarkers, showed a negative association with the risk of all fractures (P = 7.80E-08). Similar associations were observed for hip fracture.

CONCLUSIONS

Higher levels of large and very large HDL were associated with an increased risk of fractures, whereas higher lipid subclasses of LDL and VLDL were associated with a lower risk of fracture. Higher levels of VLDL subclasses in different lipid constituents were associated with increased BMD at multiple sites, while higher level of HDL was associated with decreased BMD.

A Retrospective Machine Learning Analysis to Predict 3-Month Nonunion of Unstable Distal Clavicle Fracture Patients Treated with Open Reduction and Internal Fixation

Background

This retrospective study aims to predict the risk of 3-month nonunion in patients with unstable distal clavicle fractures (UDCFs) treated with open reduction and internal fixation (ORIF) using machine learning (ML) methods. ML was chosen over traditional statistical approaches because of its superior ability to capture complex nonlinear interactions and to handle imbalanced datasets.

Methods

We collected UDCFs patients at Nanjing Luhe People's Hospital (China) between January 2015 and May 2023. The unfavorable outcome was defined as 3-month nonunion, as represented by disappeared fracture line and continuous callus. Patients meeting inclusion criteria were randomly divided into training (70%) and testing (30%) sets. Five ML models (logistic regression, random forest classifier, extreme gradient boosting, multi-layer perceptron, and category boosting) were developed. Those models were selected based on univariate analysis and refined using the Least Absolute Shrinkage and Selection Operator (LASSO). Model performance was evaluated using AUROC, AUPRC, accuracy, sensitivity, specificity, F1 score, and calibration curves.

Results

A total of 248 patients were finally included into this study, and 76 (30.6%) of them had unfavorable outcomes. While all five models showed similar trends, the CatBoost model achieved the highest performance (AUROC = 0.863, AUPRC = 0.801) with consistent identification of the risk factors mentioned above. The SHAP values identified the CCD as the significant predictor for assessing the risk of 3-month nonunion in patients with UDCFs within the Chinese demographic.

Conclusion

The refined model incorporated four readily accessible variables, wherein the CCD, HDL levels, and blood loss were associated with an elevated risk of nonunion. Conversely, the application of nerve blocks, including postoperative block, was correlated with a reduced risk. Our results suggest that ML, particularly the CatBoost model, can be integrated into clinical workflows to aid surgeons in optimizing intraoperative techniques and postoperative management to reduce nonunion rates.

Concentration and genetic regulation of sex hormone binding globulin and fracture risk in older women

OBJECTIVE

This study aimed to examine the association between concentrations of sex hormone binding globulin (SHBG) and fracture risk in community-dwelling older women and explore whether this was explained by the genetic regulation of SHBG.

METHODS

This prospective cohort study examined 4871 women aged ≥70 years who were not taking medications influencing SHBG concentrations. A genome-wide association study was undertaken to identify single nucleotide polymorphisms (SNPs) associated with SHBG concentrations. Incident fracture was confirmed by medical imaging and adjudicated by expert review committee.

RESULTS

The median age of participants was 74.0 years. Over 3.9 (standard deviation 1.4) years of follow-up, 484 participants had an incident fracture. There was a linear trend for a positive association between SHBG concentrations and fracture risk (p = 0.001), with the highest SHBG quartile associated with a significantly greater fracture risk compared with the lowest quartile (hazard ratio 1.54, 95% confidence interval 1.16-2.04, p = 0.003), adjusting for age, body mass index, alcohol consumption, smoking, diabetes, impaired renal function, treatment allocation, medications affecting bone and high-density lipoprotein cholesterol. Two independent SNPs were associated with SHBG concentrations, rs10822163 and rs727428, but neither was associated with fracture risk.

CONCLUSION

SHBG concentrations were positively associated with a greater fracture risk in community-dwelling women aged ≥70 years, which was not explained by genetic variants associated with SHBG regulation.

Association of high-density lipoprotein cholesterol with all-cause and cause-specific mortality in the general population: insights from NHANES 1999-2018

BACKGROUND

Previous studies have shown that extremely high levels of high-density lipoprotein (HDL) cholesterol are paradoxically associated with adverse outcomes in certain clinical settings. We aimed to test the hypothesis that extremely high levels of HDL cholesterol are associated with increased all-cause and cause-specific mortality in the general population.

METHODS

We included 51,235 individuals from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2018 with a median follow-up of 9.3 years. Baseline HDL cholesterol levels were measured, and mortality data were ascertained from National Death Index (NDI) records through December 31, 2019. Weighted Cox proportional hazards regression, restricted cubic spline curves, and cumulative incidence analyses were performed.

RESULTS

A U-shaped association was observed between HDL cholesterol levels and all-cause, cardiovascular and non-cardiovascular mortality in the general population. Compared with individuals with HDL cholesterol levels between 50 and 59 mg/dL, the adjusted hazard ratios (95% CIs) for those with extremely high HDL cholesterol levels (≥ 80 mg/dL) were 1.24 (1.08-1.43), 1.18 (1.03-1.36) and 1.27 (1.09-1.49) for all-cause, cardiovascular and non-cardiovascular mortality, respectively. Similar U-shaped patterns were replicated in both men and women. Further analyses of cause-specific mortality subcategories showed that extremely high HDL cholesterol levels were also associated with increased mortality from heart disease, respiratory disease, endocrine disease, and cancer.

CONCLUSION

Extremely high levels of HDL cholesterol were associated with an increased risk of all-cause, cardiovascular, and non-cardiovascular mortality in the general population. Future studies should investigate the causal factors leading to the association of elevated HDL cholesterol and mortality.

Triglycerides, high-density lipoprotein and cognitive function in middle-aged and older adults: a cross-sectional analysis

As China's population continues to age, addressing cognitive decline related to aging has become increasingly important. Simultaneously, rapid economic development has led to rising concerns about lipid metabolism disorders, particularly those involving blood lipids. Identifying modifiable risk factors early is critical to enhancing cognitive function in older adults. Thus, this study focuses on the relationship between triglycerides (TG), high-density lipoprotein (HDL), and cognitive performance to investigate potential mechanisms. A cross-sectional study was conducted using data from the 2015 China Health and Retirement Longitudinal Study (CHARLS) survey. Cognitive function was assessed across three domains: global cognition, episodic memory, and mental status. Fasting blood samples were analyzed for triglycerides and high-density lipoprotein (HDL) levels. The relationship between triglycerides, HDL, and cognitive function was examined using restricted cubic spline (RCS) analysis, multivariate linear regression, and mediation analysis. The analysis identifies a non-linear, inverse U-shaped relationship between triglycerides and both global cognition and episodic memory, with significant inflection points at a triglyceride (TG) level of 202.65 for global cognition and 115.04 for episodic memory. No non-linear relationship was observed between High-Density Lipoprotein (HDL) and cognitive outcomes, including global cognition, episodic memory, or mental status (p > 0.05). Linear mixed models indicate that HDL has a positive association with episodic memory, as shown by HDLQ1 (B = 0.0033, 95% CI: 0, 0.569), HDLQ2 (B = 0.039, 95% CI: 0.051, 0.594), and HDLQ3 (B = 0.033, 95% CI: 0.004, 0.556) compared to HDLQ4. A combined analysis of TG and HDL on episodic memory further demonstrated that the ''High-TG-low-HDL'' group (B = 0.036, 95% CI: 0.043, 0.578) had a significantly positive effect compared to the "High-HDL-low-TG" group. Mediation analysis revealed that Body Mass Index (BMI) indirectly mediated the HDL-episodic memory relationship, with a mediation effect size of 22.2%. In conclusion, this study explored the interplay between triglyceride levels, high-density lipoprotein cholesterol (HDL-C) levels, and cognitive function among middle-aged and elderly individuals in China. The findings reveal a U-shaped inverse relationship between triglyceride concentrations and cognitive ability, underscoring the need to maintain optimal triglyceride levels for cognitive health. Additionally, lower HDL levels (HDLQ1-Q3) were found to positively affect cognitive function, particularly in overall cognition and episodic memory, compared to higher HDL levels (HDLQ4). Importantly, body mass index (BMI) mediated the influence of HDL on episodic memory, with an effect size of 22.2%.

The correlation between TyG-BMI and the risk of osteoporosis in middle-aged and elderly patients with type 2 diabetes mellitus

Background and objectives

Osteoporosis (OP) has emerged as one of the most rapidly escalating complications associated with diabetes mellitus. However, the potential risk factors contributing to OP in patients with type 2 diabetes mellitus (T2DM) remain controversial. The aim of this study was to explore the relationship between triglyceride glucose-body mass index (TyG-BMI), a marker of insulin resistance calculated as Ln [triglyceride (TG, mg/dL) × fasting plasma glucose (mg/dL)/2] × BMI, and the risk of OP in T2DM patients.

Methods

This retrospective cross-sectional study enrolled 386 inpatients with T2DM, comprising both male and postmenopausal female participants aged 40 years or older. Individuals with significant medical histories or medications known to influence bone mineral density were excluded. Machine learning algorithms were employed to rank factors affecting OP risk. Logistic regression analysis was performed to identify independent influencing factors for OP, while subgroup analysis was conducted to evaluate the impact of TyG-BMI on OP across different subgroups. Restricted cubic spline (RCS) analysis was used to explore the dose-response relationship between TyG-BMI and OP. Additionally, the receiver operating characteristic (ROC) curve was utilized to assess the predictive efficiency of TyG-BMI for OP.

Results

Machine learning analysis identified TyG-BMI as the strongest predictor for type 2 diabetic osteoporosis in middle-aged and elderly patients. After adjusting for confounding factors, multivariate logistic regression analysis revealed that age, osteocalcin, and uric acid were independent influencing factors for OP. Notably, TyG-BMI also emerged as an independent risk factor for OP (95%CI 1.031-1.054, P < 0.01). Subgroup analysis demonstrated a consistent increase in OP risk with higher TyG-BMI levels across all subgroups. RCS analysis indicated a threshold effect, with the risk of OP gradually increasing when TyG-BMI exceeded 191.52. Gender-specific analysis showed increasing the risk of OP when TyG-BMI surpassed 186.21 in males and 198.46 in females, with a more pronounced trend observed in females. ROC suggested that TyG-BMI index has significant discriminative power for type 2 diabetic osteoporosis.

Conclusion

TyG-BMI has been identified as a robust predictive biomarker for assessing OP risk in middle-aged and elderly populations with T2DM.

The nonlinear association of ratio of total cholesterol to high density lipoprotein with cognition ability: evidence from a community cohort in China

Background

Cholesterol is a critical component of the human body, particularly within the brain, where it plays an essential role in maintaining cellular structure and function. In addition, the blood lipid profile has been recognized as a significant factor influencing cognitive performance. However, the association between the ratio of total cholesterol (TC) to high-density lipoprotein cholesterol (HDL-C) and cognitive function remains unclear.

Methods

This community-based, cross-sectional study was conducted using data from middle-aged and older adults (aged ≥45 years) participating in the China Health and Retirement Longitudinal Study (CHARLS). The primary exposure of interest was the ratio of TC to HDL-C, while the main outcome was cognitive function, assessed using cognition scores. The association between the TC-HDL-C ratio and cognitive performance was examined using multiple linear regression analyses and restricted cubic spline modeling to assess potential nonlinear relationships.

Results

A total of 8,914 participants were included in the analysis. Within a certain range, a higher TC-HDL-C ratio was significantly associated with improved cognitive scores (p < 0.05) among middle-aged and older adults. This relationship remained significant even after adjusting for sociodemographic and health-related factors. Moreover, restricted cubic spline analyses revealed a significant nonlinear association (p for nonlinearity <0.05) between the TC-HDL-C ratio and cognition scores. Subgroup analyses further highlighted differential effects of the TC-HDL-C ratio across specific population subgroups. Sensitivity analyses consistently supported the robustness of the observed relationship between the TC-HDL-C ratio and cognitive function.

Conclusion

Our findings confirm a significant nonlinear relationship between the TC-HDL-C ratio and cognitive performance in middle-aged and elderly individuals, even after adjusting for sociodemographic factors. These results underscore the potential importance of maintaining an appropriate TC-HDL-C ratio to support cognitive health in aging populations.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and hepatic steatosis and liver fibrosis among US adults based on NHANES

Recently, the non-high-density to high-density lipoprotein cholesterol ratio (NHHR) has gained growing attention as an indicator for predicting diseases associated with lipid metabolism. Hepatic steatosis and fibrosis are tightly associated lipid metabolism. Our study aims to analyze the correlations among NHHR, hepatic steatosis, and fibrosis. This study analysed data from 14,578 adults in the US National Health and Nutrition Examination Survey (2005-2018). The degree of hepatic steatosis was measured through the Fatty Liver Index (FLI), while liver fibrosis severity was evaluated with the Fibrosis-4 (FIB-4) index. Multivariate linear regression assessed the association between NHHR and the FLI and FIB-4 score. Smooth curve describing the relationship between NHHR and FLI or FIB-4. Additionally, a two-part linear regression model adopted in order to more accurately account for the nonlinear relationship, with threshold effects estimated through its two components. To confirm the robustness of the findings, interaction tests and subgroup analyses were conducted. The multivariate logistic regression analysis demonstrated a significantly positive correlation of lnNHHR with FLI across all three models. In Model 3, the association was (β = 11.14, 95%CI:10.38,11.90). Curve fitting indicated a nonlinear relationship. The positive correlation between lnNHHR and FLI persists across gender, BMI, and physical activity groups. Nevertheless, a notable negative correlation between lnNHHR and FIB-4 was observed in all three models. In Model 3, the relationship between lnNHHR and FIB-4 was as follows: (β = -0.20; 95% CI: -0.22, -0.17). Curve fitting revealed a V-shaped relationship, with threshold effect analysis identifying a breakpoint at 1.51. Above this threshold, the relationship was found to be statistically insignificant (p-value = 0.424). Receiver operating characteristic (ROC) curve analysis demonstrated that NHHR exhibited better predictive performance for MASLD compared to non-HDL-C, HDL-C, and LDL-C/HDL-C. The current study's findings suggest that elevated levels of NHHR correlate with a greater risk of hepatic steatosis among adults in the U.S. Our findings imply that NHHR may be a valuable tool in improving MASLD prevention strategies in the general population.

Fracture Risk Assessment in Metabolic Syndrome in Terms of Secondary Osteoporosis Potential. A Narrative Review

Osteoporosis is a major global public health problem with the associated bone fractures contributing significantly to both morbidity and mortality. In many countries, osteoporotic fractures will affect one in three women and one in five men over the age of 50. Similarly, diabetes, obesity, and metabolic syndrome (MetS) are among the leading public health problems due to their worldwide prevalence and burden on health budgets. Although seemingly disparate, metabolic disorders are known to affect bone health, and the interaction between fat and bone tissue is increasingly well understood. For example, it is now well established that diabetes mellitus (both type 1 and 2) is associated with fracture risk. In this narrative review, we focus on the potential link between MetS and bone health as expressed by bone mineral density and fracture risk. This narrative review demonstrates the association of MetS and its components with increased fracture risk, and also highlights the need for fracture risk assessment in patients with obesity and MetS.

U-shaped association between TC/HDL-C ratio and osteoporosis risk in older adults

This study aimed to evaluate the association between the total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio and the risk of osteoporosis in older adults. A cross-sectional analysis was conducted using data from 7,465 individuals aged 60 and above from the 2005-2020 National Health and Nutrition Examination Survey (NHANES). The TC/HDL-C ratio was calculated and divided into quartiles. Osteoporosis was defined by self-reported physician diagnosis or dual-energy x-ray absorptiometry (DXA) measurements. Multivariable logistic regression models assessed the association between the TC/HDL-C ratio and osteoporosis prevalence. Restricted cubic splines were used to explore non-linear associations and threshold effects. Among the participants, 1,608 had osteoporosis. A higher TC/HDL-C ratio was inversely associated with osteoporosis (OR: 0.92, 95% CI: 0.86-0.99, p = 0.02). The analysis revealed a U-shaped association (p for nonlinearity = 0.005) with a threshold at 4.66. Below this threshold, the TC/HDL-C ratio was negatively associated with osteoporosis (OR: 0.83, 95% CI: 0.72-0.94, p = 0.010), while no significant association was observed above the threshold. In sex-specific analyses, a U-shaped relationship was found in women, with a threshold at 4.35 (p for nonlinearity = 0.0016), but no significant association was found in men. The TC/HDL-C ratio demonstrates a U-shaped association with osteoporosis risk in older adults, particularly in women. Further longitudinal studies are required to validate these findings and determine optimal lipid management strategies for osteoporosis prevention.

A Novel CT-Based Fracture Risk Prediction Model for COPD Patients

RATIONALE AND OBJECTIVES

The aim of this study was to develop and validate a novel computed tomography (CT)-based fracture risk assessment model (FRCT) specifically tailored for patients suffering from chronic obstructive pulmonary disease (COPD).

METHODS

We conducted a retrospective analysis encompassing a cohort of 284 COPD patients, extracting data on demographics, clinical profiles, pulmonary function tests, and CT-based bone quantification metrics. The Boruta feature selection algorithm was employed to identify key variables for model construction, resulting in a user-friendly nomogram.

RESULTS

Our analysis revealed that 37.32% of the patients suffered fragility fractures post-follow-up. The FRCT model, integrating age, cancellous bone volume, average cancellous bone density, high-density lipoprotein levels, and prior fracture incidence, demonstrated superior predictive accuracy over the conventional fracture risk assessment tool (FRAX), with a C-index of 0.773 in the training group and 0.797 in the validation group. Calibration assessments via the Hosmer-Lemeshow test confirmed the model's excellent fit, and decision curve analysis underscored the FRCT model's substantial positive net benefit.

CONCLUSION

The FRCT model, leveraging opportunistic CT screening, offers a highly accurate and personalized approach to fracture risk prediction in COPD patients, surpassing the capabilities of existing tools. This model is poised to become an indispensable asset for clinicians in managing osteoporotic fracture risks within the COPD population.

Development and validation of a predictive model and tool for functional recovery in patients after postero-lateral interbody fusion

OBJECTIVE

The postoperative recovery of patients with lumbar disc herniation (LDH) requires further study. This study aimed to establish and validate a predictive model for functional recovery in patients with LDH and explore associated risk factors.

METHOD

Patients with LDH undergoing PLIF admitted from January 1, 2018 to December 31, 2022 were included, and patient data were prospectively collected through follow-up. The training and validation cohorts were randomly assigned in a 7:3 ratio. To pool data variables LASSO regression was used. The pooled variables were subsequently included in binary logistic regression analyses, construct risk prediction models, and plot nomograms. Additionally, recovery prediction models and interactive web page calculators were developed using R Shiny.

RESULTS

Overall, 1,097 patients with LDH following PLIF were included in this study. Regarding patients' economic and functional scores, 927 (84.5%) received excellent scores. Key indicators significantly were screened. Multivariate analysis showed that age, season, occupation, HDL-C, smoking, weekly exercise time, and osteoporosis were independent risk factors for postoperative recovery. The C-index of the model was 0.776 (95% CI: 0.7312-0.8208) and 0.804 (95% CI: 0.7408-0.8673) for the training and validation cohorts, respectively. The H-L test showed good fitting of the model (all P > 0.05). The DCA curve showed the best clinical efficacy when the threshold probability was in the ranges of 0-0.71 and 0.79-0.84. The interactive web calculator is accessed at https://postoperativerecoveryofldh.shinyapps.io/DynNomapp/ .

CONCLUSION

The predictive tools derived from this study can provide realistic and personalized expectations of postoperative outcomes for patients undergoing lumbar spine surgery.

Associations of Serum Lipid Traits With Fracture and Osteoporosis: A Prospective Cohort Study From the UK Biobank

BACKGROUND

Previous studies reveal inconsistent associations between serum lipid traits and the risks of fractures and osteoporosis in the general population.

METHODS

This prospective cohort study analysed data from 414 302 UK Biobank participants (223 060 women and 191 242 men, aged 37-73 years) with serum lipid measurements: apolipoprotein A (Apo A), apolipoprotein B (Apo B), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and lipoprotein A (Lp(a)). Multivariable Cox proportional hazard models with penalized cubic splines were used to explore potential nonlinear associations of each lipid trait with the risks of fractures and osteoporosis. Subgroup analyses by age, sex, BMI categories and pre-existing cardiovascular disease were conducted. Mediation analyses using the g-formula were performed to quantify to which extent bone mineral density (BMD) may mediate the association between serum lipids and fracture risk.

RESULTS

Over a median follow-up period of 13.8 years, 25 918 (6.8%) of the 383 530 participants without prior fracture had incident fracture cases, and 7591 (4.1%) of the 184 919 participants with primary care data and without baseline osteoporosis were diagnosed with osteoporosis. TG had nonlinear associations with fractures and osteoporosis, whereas Apo B, TC and LDL-C had linear associations. There were also nonlinear associations of Apo A and HDL-C with fractures. Individuals in the highest quintiles for Apo A (fracture: HR 1.15 [95% CI 1.10, 1.21]; osteoporosis: HR 1.13 [1.02, 1.25]) and HDL-C (fracture: HR 1.27 [1.20, 1.34]; osteoporosis: HR 1.31 [1.18, 1.46]) were associated with higher risks of fractures and osteoporosis. Conversely, those in the highest quintile for Apo B (fracture: HR 0.85 [0.81, 0.89]; osteoporosis: HR 0.86 [0.79, 0.94]), LDL-C (fracture: HR 0.89 [0.85, 0.93]; osteoporosis: HR 0.91 [0.83, 1.00]) and TG (fracture: HR 0.78 [0.74, 0.82]; osteoporosis: HR 0.75 [0.68, 0.82]) were associated with lower risks. The associations of Apo A (ratio of HR [RHR] 1.05 [1.02, 1.09]) and HDL-C (RHR 1.06 [1.03, 1.09]) with fracture risk were more pronounced in men compared to women. Except for TG and Lp(a), the associations between serum lipids and fractures appear to be partially mediated through BMD (mediation proportions: 5.30% to 40.30%), assuming causality.

CONCLUSIONS

Our study reveals a complex interplay between different lipid markers and skeletal health, potentially partially mediated through BMD. Routine lipid profile assessments, including HDL-C and Apo A among other lipid traits, may be integrated into the strategies for fracture risk stratification.

Advantages of statin usage in preventing fractures for men over 50 in the United States: National Health and Nutrition Examination Survey

OBJECTIVES

The relationship between statin treatment and fracture risk is still controversial, especially in in patients with cardiovascular diseases (CVDs). We aim to determine whether statin therapy affects the occurrence of fractures in the general US population and in patients with CVDs.

METHODS

Epidemiological data of this cross-sectional study were extracted from the National Health and Nutrition Examination Survey (NHANES, 2001-2020, n = 9,893). Statins records and fracture information were obtained from the questionnaires. Weighted logistic regressions were performed to explore the associations between statin and the risk of fracture.

RESULTS

Statin use was found to be associated with reduced risk of fracture mainly in male individuals aged over 50 years old and taking medications for less than 3 years, after adjusted for confounders including supplements of calcium and vitamin D. The protective effects were only found in subjects taking atorvastatin and rosuvastatin. We found null mediation role of LDL-C and 25(OH)D in such effects. Statin was found to reduce fracture risk in patients with cardiovascular diseases (CVDs, OR: 0.4366, 95%CI: 0.2664 to 0.7154, P = 0.0014), and in patients without diabetes (OR: 0.3632, 95%CI: 0.1712 to 0.7704, P = 0.0091).

CONCLUSIONS

Statin showed advantages in reducing risk of fracture in male individuals aged over 50 years old and taking medications for less than 3 years. More research is needed to determine the impact of gender variations, medication duration, and diabetes.

The association between HDL-c levels and computed tomography-based osteosarcopenia in older adults

OBJECTIVE

Associations between serum lipid levels and osteoporosis and sarcopenia have been reported. However, few studies have reported a link between serum lipid levels and osteosarcopenia. In the present study, we investigated the association between serum high-density lipoprotein cholesterol (HDL-c) and osteosarcopenia.

METHODS

A total of 1995 participants aged 50 years and above who underwent chest CT physical examinations from 2016 to 2019 were included. Demographic information, including age, sex, and body mass index, and laboratory data, including liver and kidney function, blood lipids (HDL-c, low-density lipoprotein cholesterol (LDL-c), triglyceride (TG), total cholesterol (TC), blood glucose, and serum albumin, were collected from the medical records system. Osteosarcopenia was defined on the basis of the presence of low bone mass (bone CT values < 110 HU) and low muscle mass of bilateral erector spinae (< 25.0 cm² in men and < 20.0 cm2 in women). The relationships between HDL-c (continuous data and categorical data) and osteosarcopenia were analyzed via multivariable logistic regression and restricted cubic spline analysis.

RESULTS

One hundred forty-one patients with osteosarcopenia (7.7%) were observed. The individuals with osteosarcopenia had significantly greater HDL-c levels than did those without osteosarcopenia (1.65 ± 0.30 vs. 1.49 ± 0.34 mmol/L, P < 0.001). Multivariate logistic regression revealed that HDL-c (odds ratio (OR) = 2.72, 95% confidence interval (CI): 1.30-5.69) was associated with osteosarcopenia. The third and fourth HDL-c quartiles were significantly related to a greater incidence of osteosarcopenia (OR = 3.36, 95% CI: 1.66-6.80; OR = 3.66, 95% CI: 1.67-8.01) than the first quartile was. Similar trends were observed in the male population. For female individuals, the fourth HDL-c quartile was significantly related to a greater incidence of osteosarcopenia than the first quartile was (OR = 2.73, 95% CI: 1.03-7.21). Restricted cubic splines revealed similar relationships between HDL-c and osteosarcopenia.

CONCLUSION

High serum HDL-c levels were associated with the risk of osteosarcopenia in older adults.

Elevations of N-Terminal Mid-Fragment of Osteocalcin and Cystatin C Levels are Associated with Disorders of Glycolipid Metabolism and Abnormal Bone Metabolism in Patients with Type 2 Diabetes Mellitus Complicated with Osteoporosis

ABSTRACT

Type 2 diabetes mellitus (T2DM) patients always develop osteoporosis (OP). We examined correlations of N-terminal mid-fragment of osteocalcin (N-MID) and cystatin C (Cys C) levels with glycolipid metabolism, bone metabolism markers, and bone mineral density (BMD) in elderly T2DM-OP patients. Grouping was performed as per whether T2DM patients developed OP (OP group) or not (N-OP group). N-MID and Cys C were measured using enzyme-linked immunosorbent assay, with correlations with glycolipid metabolism, bone metabolism indicators, and BMD analyzed using Pearson's correlation coefficient. Elderly T2DM-OP patients showed elevated disease duration, age, body mass index, glycated hemoglobin (HbA1c), Homer's insulin resistance (HOMA-IR), total cholesterol (TC), beta-carboxy-terminal crosslinked telopeptide of type 1 collagen (β-CTX), tartrate-resistant acid phosphatase 5b (TRACP-5b), N-MID and Cys C levels, and reduced high-density lipoprotein cholesterol (HDL-C), bone alkaline phosphatase (B-ALP), aminoterminal propeptide of type I procollagen (PINP), carboxyterminal propeptide of type I procollagen (PICP), BMD, and calcium supplementation. N-MID and Cys C were positively correlated with HbA1c, HOMA-IR, TC, β-CTX, and TRACP-5b and negatively with HDL-C, B-ALP, PINP, PICP, and BMD in elderly T2DM-OP patients. Conclusively, the abnormal elevations of serum N-MID and Cys C were associated with glycolipid metabolism disorder, abnormal bone metabolism, and decreased BMD in elderly T2DM-OP patients.

High-density lipoprotein cholesterol level and risk of muscle strength decline and sarcopenia in older adults

BACKGROUND

Recent studies have demonstrated that very high high-density lipoprotein cholesterol (HDL-C) level was paradoxically linked with higher risk of cardiovascular mortality, all-cause mortality, and several age-related diseases. However, whether very high HDL-C level is associated with a higher risk of sarcopenia in older adults remains unclear. We aimed to investigate the association between HDL-C level and the risk of developing sarcopenia and low grip strength over time in older adults.

METHODS

Participants were from the ongoing China Health and Retirement Longitudinal Study (CHARLS), which includes a nationally representative sample of adults aged ≥45 years and was performed from 2011 to 2020 with follow-ups every two to three years. The current study included 4031 participants aged ≥60 years. Muscle health-related data were collected in waves 2011, 2013, and 2015. Based on HDL-C level at baseline, participants were categorized into five groups: <35 mg/dl, 35-40 mg/dl, 40-60 mg/dl, 60-70 mg/dl and >70 mg/dl. The main outcomes were incident sarcopenia and incident low grip strength over follow-up. Low grip strength and sarcopenia were defined according to the 2019 Consensus by the Asian Working Group for Sarcopenia. Cox proportional-hazard regression was performed to investigate the association between HDL-C level and the risk of developing sarcopenia and low grip strength in older adults.

RESULTS

The mean age of study sample was 67.3 (SD 6.1) years, and 49.6% were male. During an average 3.7-year follow-up, 409 (10.1%) participants developed sarcopenia and 771 (21.1%) developed low grip strength. Non-linear association was observed between HDL-C level and the hazard of developing sarcopenia and low grip strength. The multivariable model showed that compared to the reference group (40-60 mg/dl), older adults with very high HDL-C level (>70 mg/dl) had a significantly higher risk of developing sarcopenia (HR 1.69, 95% CI 1.28-2.23) and low grip strength (HR 1.23 95% CI 1.00-1.51). Stratified analyses by sex revealed similar association.

CONCLUSIONS

We present the first longitudinal evidence that very high HDL-C level was associated with a significantly higher risk of muscle strength decline and developing sarcopenia in older adults. It is essential to monitor the muscle health of older adults with very high HDL-C level in clinical practice.

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

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.

Association of Retinal Nerve Fiber Layer Thinning With Elevated High Density Lipoprotein Cholesterol in UK Biobank

Purpose

The purpose of this study was to investigate the association between retinal nerve fiber layer (RNFL) thickness and high-density lipoprotein cholesterol (HDL-C) in a healthy population.

Methods

This cross-sectional study included 31,738 UK Biobank participants with high quality optical coherence tomography (OCT) images, excluding those with neurological or ocular diseases. The locally estimated scatterplot smoothing (LOESS) curve and multivariable piecewise linear regression models were applied to assess the association between HDL-C and RNFL thickness, and HDL-C subclasses were further analyzed using nuclear magnetic resonance (NMR) spectroscopy.

Results

Multivariate piecewise linear regression revealed that high HDL-C levels (>1.7 mmol/L in women or > 1.5 mmol/L in men) were associated with thinner RNFL thickness (women: β = -0.13, 95% confidence interval [CI] = -0.23 to -0.02, P = 0.017; male: β = -0.23, 95% CI = -0.37 to -0.10, P = 0.001). Conversely, a significant positive association between HDL-C and RNFL thickness was observed when HDL-C was between 1.4 and 1.7 mmol/L for female participants (β = 0.13, 95% CI = 0.02 to 0.24, P = 0.025). NMR analysis showed that these associations are potentially driven by distinct HDL-C subclasses.

Conclusions

This study revealed an association between HDL-C levels and retinal markers of neurodegenerative diseases, suggesting that elevated HDL-C may serve as a new risk factor for neurodegenerative conditions. These findings may contribute to the implementation of preventive interventions and improved patient outcomes.

Non-diabetic elderly populations: the MHR as a protective factor against bone abnormalities

Objectives

In China, osteoporosis has become a major health concern among elderly population, imposing significant burden on the country's social and economic systems. The monocyte to high-density lipoprotein ratio (MHR) has been currently recommended as a novel marker of inflammation and oxidative stress associated with osteoporosis in type 2 diabetes mellitus (T2DM). However, its reliability in non-diabetic elderly populations remains unclear. The present study was to evaluate the association between MHR and osteoporosis in a non-diabetic elderly population.

Methods

The clinical data of 240 non-diabetic elderly subjects (115 in the osteoporosis group and 125 in the normal bone group) were retrospectively analyzed and all statistical analyses were performed by using SPSS 26.0.

Results

Differences in age, neutrophils, lymphocytes, monocytes, MHR, uric acid, creatinine, triglycerides,and high-density lipoprotein cholesterol were found to be statistically significant between the two groups. A binary logistic regression model was conducted by including age, MHR, UA and Cr as variables. The results showed that age was an independent risk factor and MHR was an independent protective factor for bone abnormality in the non-diabetic elderly population. The ROC analysis showed that the area under the curve for the predictive effect of MHR, age and their combined test on osteoporosis in non-diabetic elderly populations was 0.623, 0.728 and 0.761, respectively; the correlation analysis showed that MHR was positively correlated with lumbar and hip BMD, and negatively associated with femoral neck stress ratio, femoral intertrochanteric stress ratio, and femoral stem stress ratio, showing statistically significant differences (P<0.05).

Conclusions

For the non-diabetic elderly population: the MHR is a protective factor against bone abnormalities and was significantly higher in the normal bone group than in the abnormal bone group.

Association between blood lipid levels and the risk of liver cancer: a systematic review and meta-analysis

PURPOSE

The association between blood lipid levels and the risk of developing liver cancer remains a subject of ongoing debate. To elucidate this association, we conducted a meta-analysis by systematically incorporating data from all relevant prospective cohort studies.

METHODS

We conducted a systematic search of the PubMed, Embase, Web of Science, and Cochrane Library databases covering studies published from database inception through July 2023. This study included prospective cohort studies related to lipid profiles (e.g., total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels) that reported hazard ratios (HRs) or relative risks (RRs) with corresponding 95% confidence intervals (95% CIs) to investigate their association with the risk of liver cancer. During the analysis process, we used fixed-effects or random-effects models based on the level of heterogeneity among the studies and obtained pooled risk ratios using these models. To ensure the robustness and reliability of the study findings, we also conducted sensitivity analyses and publication bias analyses.

RESULTS

After conducting a systematic search, 12 studies were identified from a total of 11,904 articles and were included in the meta-analysis. These studies included a combined population of 10,765,221 participants, among whom 31,055 cases of liver cancer were reported. The analysis revealed that the pooled HR for the serum TC concentration (highest versus lowest) was 0.45 (95% CI = 0.35-0.58, I2 = 78%). For TGs, the HR was 0.67 (95% CI = 0.46-0.96, I2 = 86%), while for HDL-C, the HR was 0.72 (95% CI = 0.58-0.90, I2 = 65%). The HR for LDL-C was 0.51 (95% CI = 0.23-1.13, I2 = 93%).

CONCLUSION

The findings of this study indicate that serum TC, TG, and HDL-C levels are negatively associated with liver cancer risk, suggesting that higher concentrations of these lipids are associated with a reduced risk of liver cancer. However, no significant association has been found between LDL-C levels and liver cancer risk.

Confounding association between plasma HDL-C levels and increased fracture risk: A correspondence

Background

This article explores the association between fractures, particularly in the elderly, and elevated plasma high-density lipoprotein cholesterol (HDL-C) levels. The study challenges the conventional idea of HDL-C as "good cholesterol" by revealing its potential role as a risk factor for fractures. Factors contributing to fractures in the elderly, such as diminishing bone strength due to aging-related tissue breakdown, are discussed. Sedentary lifestyles, low bone mineral density (BMD), and habits like smoking and alcohol consumption compound fracture susceptibility.

Materials and Methods

The study delves into mechanisms linking elevated HDL-C to fractures, using data from the ASPREE-Fracturesub-study of the ASPREE trial involving Australian and American participants aged 65 and above.

Results

The study showed that over a 4-year period, elevated HDL-C levels in healthy older people were linked to a 14% higher fracture risk. This revelation expands the understanding of fracture risk factors beyond the established norms.

Conclusion

The article emphasizes the need to reconsider HDL-C's traditional role as an indicator of cardiovascular health, particularly in light of medications like Statins and Anacetrapib that raise HDL-C levels. It calls for further exploration into the relationship between HDL-C, fractures at varying sites, and different age groups. Practical implications involve incorporating fracture risk associated with high HDL-C into clinical considerations, alongside advocating lifestyle changes for optimal HDL-C levels. In summary, this study prompts a reevaluation of HDL-C's implications in clinical practice, demanding further investigation into the intricacies of this relationship.

Chronic Kidney Disease in Patients with Hip Fracture: Prevalence and Outcomes

Objective. Although the association between chronic kidney disease (CKD) and osteoporotic fractures is well established, data on CKD combined with hip fracture (HF) are scarce and controversial. We aimed to assess in patients with HF the prevalence of CKD, its impact on hospital mortality and length of stay (LOS) and to determine the prognostic value of CKD to predict hospital outcomes. Methods. Prospectively collected clinical data were analysed in 3623 consecutive HF patients aged ≥65 years (mean age 83.4 ± 7.50 [standard deviation] years; 74.4% females). Results. CKD among older patients with HF is highly prevalent (39.9%), has different clinical characteristics, a 2.5-fold higher mortality rate, and 40% greater risk of prolonged LOS. The strongest risk for a poor outcome was advanced age (>80 years). The risk of death substantially increases in combination with chronic disorders, especially coronary artery disease, anaemia, hyperparathyroidism, and atrial fibrillation; models based only on three variables—CKD stage, age >80, and presence of a specific chronic condition—predicted in-hospital death with good discrimination capability (AUC ≥ 0.700) and reasonable accuracy, the number needed to predict ranged between 5.7 and 14.5. Only 12% of HF patients received osteoporotic drugs prefracture. Conclusion. In HF patients with CKD, the risk of adverse outcomes largely increases in parallel with worsening kidney function and, especially, in combination with comorbidities; models based on three admission variables predict a fatal outcome. Assessment of renal function is essential to preventing osteoporotic fractures.

Sex-dependent associations of plasma high-density lipoprotein cholesterol and mortality risk in healthy older men and women: two prospective cohort studies

The relationship between high plasma high-density lipoprotein cholesterol (HDL-C) and cause and mortality are not well established in healthy older people. This study examined the associations between HDL-C levels and mortality in initially healthy older men and women. This analysis included participants from the Aspirin in Reducing Events in the Elderly (ASPREE; n=18,668) trial and a matched cohort from the UK Biobank (UKB; n=62,849 ≥65 years). Cox regression was used to examine hazard ratios between HDL-C categories <1.03 mmol/L, 1.03-1.55 mmol/L (referent category), 1.55-2.07 mmol/L, and >2.07 mmol/L and all-cause, cancer, cardiovascular disease (CVD), and "non-cancer non-CVD" mortality. Genetic contributions were assessed using a polygenic score for HDL-C. Among ASPREE participants (aged 75±5 years), 1836 deaths occurred over a mean follow-up of 6.3±1.8 years. In men, the highest category of HDL-C levels was associated with increased risk of all-cause (HR 1.60, 95% CI 1.26-2.03), cancer (HR 1.37, 95% CI 0.96-2.00), and "non-cancer non-CVD" mortality (HR 2.35, 95% CI 1.41-3.42) but not CVD mortality (HR 1.08, 95% CI 0.60-1.94). The associations were replicated among UKB participants (aged 66.9±1.5 years), including 8739 deaths over a mean follow-up of 12.7±0.8 years. There was a non-linear association between HDL-C levels and all-cause and cause-specific mortality. The association between HDL-C levels and mortality was unrelated to variations in the HDL-C polygenic score. No significant association was found between HDL-C levels and mortality in women. Higher HDL-C levels are associated with increased risk from cancer and "non-cancer non-CVD" mortality in healthy older men but no such relationship was observed in women.

Reevaluating elevated HDL cholesterol levels in healthy older persons as a risk factor for various disease states

This article reviews the role of high-density lipoprotein cholesterol (HDL-C) in the elderly population, questioning the established view that advocates the ubiquitous health benefits of HDL cholesterol. High levels of HDL-C have been found to be associated with an increased risk of debilitating fractures, dementia, and cardiovascular disease, predominantly affecting older men, through the use of large population-based studies such as the ASPREE trial and the UK Biobank. Possible mechanisms are closely linked to cholesterol crystallization and altered HDL particle function. These findings call for a refinement of the understanding of high-density lipoprotein cholesterol (HDL-C), which implies adjustments to clinical guidelines and risk assessment strategies in older populations.

Fracture patterns in adult onset type 1 diabetes and associated risk factors - A nationwide cohort study

OBJECTIVE

This study aimed to determine the hazard ratios (HR) for various fracture sites and identify associated risk factors in a cohort of relatively healthy adult people with newly diagnosed type 1 diabetes (T1D).

METHODS

The study utilized data from the UK Clinical Practice Research Datalink GOLD (1987-2017). Participants included people aged 20 and above with a T1D diagnosis code (n = 3281) and a new prescription for insulin. Controls without diabetes were matched based on sex, year of birth, and practice. Cox regression analysis was conducted to estimate HRs for any fracture, major osteoporotic fractures (MOFs), and peripheral fractures (lower-arm and lower-leg) in people with T1D compared to controls. Risk factors for T1D were examined and included sex, age, diabetic complications, medication usage, Charlson comorbidity index (CCI), hypoglycemia, previous fractures, falls, and alcohol consumption. Furthermore, T1D was stratified by duration of disease and presence of microvascular complications.

RESULTS

The proportion of any fracture was higher in T1D (10.8 %) than controls (7.3). Fully adjusted HRs for any fracture (HR: 1.43, CI95%: 1.17-1.74), MOFs (HR: 1.46, CI95%: 1.04-2.05), and lower-leg fractures (HR: 1.37, CI95%: 1.01-1.85) were statistically significantly increased in people with T1D compared to controls. The primary risk factor across all fracture sites in T1D was a previous fracture. Additional risk factors at different sites included previous falls (HR: 1.64, CI95%: 1.17-2.31), antidepressant use (HR: 1.34, CI95%: 1.02-1.76), and anxiolytic use (HR: 1.54, CI95%: 1.08-2.29) for any fracture; being female (HR: 1.65, CI95%: 1.14-2.38) for MOFs; the presence of retinopathy (HR: 1.47, CI95%: 1.02-2.11) and previous falls (HR: 2.04, CI95%: 1.16-3.59) for lower-arm and lower-leg fractures, respectively. Lipid-lowering medication use decreased the risk of MOFs (HR: 0.66, CI95%: 0.44-0.99). Stratification of T1D by disease duration showed that the relative risk of any fracture in T1D did not increase with longer diabetes duration (0-4 years: HR: 1.52, CI95%: 1.23-1.87; 5-9 years: HR: 1.30, CI95%: 0.99-1.71; <10 years: HR: 1.07, CI95%: 0.74-1.55). Similar patterns were observed for other fracture sites. Moreover, the occurrence of microvascular complications in T1D was linked to a heightened risk of fractures in comparison to controls. However, when considering the T1D cohort independently, the association was not statistically significant.

CONCLUSION

In a cohort of relatively healthy and newly diagnosed people with T1D HRs for any fracture, MOFs, and lower-leg fractures compared to controls were increased. A previous fracture was the most consistent risk factor for a subsequent fracture, whereas retinopathy was the only diabetes related one. We postulate a potential initial fracture risk, succeeded by a subsequent risk reduction, which might potentially increase in later years due to the accumulation of complications and other factors.

Association of plasma high-density lipoprotein cholesterol level with risk of incident dementia: a cohort study of healthy older adults

Background

Recent studies have reported associations between high plasma high-density lipoprotein cholesterol (HDL-C) levels and risk of all-cause mortality, age-related macular degeneration, sepsis and fractures, but associations with dementia risk remain unclear. To determine whether high plasma HDL-C levels are associated with increased incident dementia risk in initially-healthy older people.

Methods

We conducted a post-hoc analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial; a double-blind, randomized, placebo-controlled trial of daily low-dose aspirin in healthy older people. ASPREE recruited 16,703 participants aged ≥70 years (from Australia) and 2411 participants aged ≥65 years (from the US) between 2010 and 2014. Participants had no diagnosed cardiovascular disease, dementia, physical disability, or life-threatening illness at enrolment and were cognitively healthy (3MS score ≥78). All-cause dementia was a primary trial endpoint, and determined by DSM-IV criteria. Cox regression was used to examine hazard ratios between HDL-C categories <40 mg/dL, 40-60 mg/dL (reference category), 60-80 mg/dL, and >80 mg/dL and dementia. Restricted cubic spline curves were used to determine nonlinear associations. Data analysis was performed from October 2022 to January 2023.

Findings

Of the 18,668 participants, 850 (4.6%) cases of incident dementia were recorded over 6.3 (SD 1.8) years. Participants with high HDL-C (>80 mg/dL) had a 27% higher risk of dementia (HR 1.27, 95% CI 1.03, 1.58). Age stratified analyses demonstrated that the risk of incident dementia was higher in participants ≥75 years compared to participants <75 years (HR 1.42, 95% CI 1.10, 1.83 vs HR 1.02, 95% CI 0.68, 1.51). Associations remained significant after adjusting for covariates including age, sex, country of enrolment, daily exercise, education, alcohol consumption, weight change over time, non-HDL-C, HDL-C-PRS, and APOE genotype.

Interpretation

In a population of initially-healthy older adults aged ≥75 years, high HDL-C levels were associated with increased risk of all-cause dementia.

Funding

National Institutes of Health, USA; National Health and Medical Research Council Australia; Monash University (Melbourne, VIC, Australia); and the Victorian Cancer Agency (Australia).

The interplay between circulating high-density lipoprotein, age and fracture risk: a new cohort study and systematic meta-analysis

Previous findings on the association between high-density lipoprotein cholesterol (HDL-C) and fracture have yielded inconsistent results and it is unclear if the association varies with age and sex. We sought to evaluate the prospective association between HDL-C levels and fracture risk and assess if the association is modified by age and sex. Circulating HDL-C levels were measured at baseline in a population-based sample of 2,448 men aged 42-61 years. Cox regression was used to estimate hazard ratios (HRs) and 95% CIs. Incident fractures (n = 134) occurred during a median follow-up of 25.7 years. In analysis adjusted for several risk factors, the HR (95% CI) for fractures was 1.00 (0.85-1.20) per 1 standard deviation (SD) increase in HDL-C levels. Comparing the extreme tertiles of HDL-C levels, the corresponding adjusted HR (95% CI) was 0.94 (0.62-1.45). In a meta-analysis of eight cohort studies (including the current study) comprising 74,378 participants and 4,621 fracture cases, the fully-adjusted risk estimate (95% CI) for fracture was 1.03 (0.96-1.10) per 1SD increase in HDL-C levels and 1.05 (0.92-1.20) comparing extreme tertiles of HDL-C. The pooled risk estimate (95% CIs) for fracture per 1SD increase were 1.09 (1.01-1.17) and 0.98 (0.93-1.04) for age groups ≥ 60 and < 60 years, respectively, and the corresponding risks comparing the extreme tertiles of HDL-C levels were 1.21 (1.09-1.33) and 0.95 (0.85-1.07) (p-value for interaction < 0.05). Age may modify the association between HDL-C levels and fracture risk - an increased fracture risk associated with increased HDL-C levels is only evident in older age (≥ 60 years).

Mechanistic advances in osteoporosis and anti-osteoporosis therapies

Osteoporosis is a type of bone loss disease characterized by a reduction in bone mass and microarchitectural deterioration of bone tissue. With the intensification of global aging, this disease is now regarded as one of the major public health problems that often leads to unbearable pain, risk of bone fractures, and even death, causing an enormous burden at both the human and socioeconomic layers. Classic anti-osteoporosis pharmacological options include anti-resorptive and anabolic agents, whose ability to improve bone mineral density and resist bone fracture is being gradually confirmed. However, long-term or high-frequency use of these drugs may bring some side effects and adverse reactions. Therefore, an increasing number of studies are devoted to finding new pathogenesis or potential therapeutic targets of osteoporosis, and it is of great importance to comprehensively recognize osteoporosis and develop viable and efficient therapeutic approaches. In this study, we systematically reviewed literatures and clinical evidences to both mechanistically and clinically demonstrate the state-of-art advances in osteoporosis. This work will endow readers with the mechanistical advances and clinical knowledge of osteoporosis and furthermore present the most updated anti-osteoporosis therapies.

The Role of Consumption of Molybdenum Biofortified Crops in Bone Homeostasis and Healthy Aging

Osteoporosis is a chronic disease and public health issue in aging populations. Inadequate intake of micronutrients increases the risk of bone loss during an adult's lifespan and therefore of osteoporosis. The aim of the study was to analyze the effects of consumption of biofortified crops with the micronutrient molybdenum (Mo) on bone remodeling and metabolism in a population of adults and seniors. The trial enrolled 42 senior and 42 adult people randomly divided into three groups that consumed lettuce biofortified with molybdenum (Mo-biofortified group) or without biofortification (control group) or molybdenum in a tablet (Mo-tablet group) for 12 days. We chose an experimental period of 12 days because the bone remodeling marker levels are influenced in the short term. Therefore, a period of 12 days allows us to determine if there are changes in the indicators. Blood samples, obtained at time zero and at the end of the study, were compared within the groups adults and seniors for the markers of bone resorption, C-terminal telopeptide (CTX) and bone formation osteocalcin, along with the markers of bone metabolism, parathyroid hormone (PTH), calcitonin, albumin-adjusted calcium, vitamin D, phosphate and potassium. Consumption of a Mo tablet did not affect bone metabolism in the study. Consumption of Mo-biofortified lettuce significantly reduced levels of CTX and PTH and increased vitamin D in adults and seniors while levels of osteocalcin, calcitonin, calcium, potassium and phosphate were not affected. The study opens up new considerations about the role of nutrition and supplementation in the prevention of chronic diseases in middle-aged and older adults. Consumption of Mo-biofortified lettuce positively impacts bone metabolism in middle-aged and older adults through reduced bone resorption and improved bone metabolism while supplementation of Mo tablets did not affect bone remodeling or metabolism. Therefore, Mo-biofortified lettuce may be used as a nutrition intervention to improve bone homeostasis and prevent the occurrence of osteoporosis in the elderly.