The Association of Lipids and Lipoproteins with Hip Fracture Risk: The Cardiovascular Health Study

• Type of Material: Article
• Authors: Joshua Barzilay, Emory University; Petra Buzkova, University of Washington; Lewis H Kuller, University of Pittsburgh; Jane A Cauley, University of Pittsburgh; Howard A Fink, VA Health Care System, Minneapolis; Kerry Sheets, University of Minnesota, Minneapolis; John A Robbins, University of California Davis; Laura D Carbone, Augusta University; Rachel E Elam, Augusta University; Kenneth J Mukamal, Beth Israel Deaconess Medical Center
• Language: English
• Date: 2022-08-26
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amjmed.2022.05.024
• Title of Journal or Parent Work: AMERICAN JOURNAL OF MEDICINE
• Volume: 135
• Issue: 9
• Start Page: 1101
• End Page: +
• Grant/Funding Information: 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.; 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).
• Keywords: DENSITY; Hip fracture; Life Sciences & Biomedicine; WOMEN; METABOLIC SYNDROME; NATIONAL-HEALTH; Science & Technology; ADULTS; OSTEOPOROSIS; General & Internal Medicine; DISEASE; Medicine, General & Internal; CHOLESTEROL; Lipoprotein particle; Lipid

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.