Lipid-Lowering Drugs Suggest Unexpected Protective Benefit Against Hip Fracture Risk

Clinical significance

The associations of lipid levels and lipoprotein levels and size with hip fracture risk are uncertain.
In this study, HDL-c and LDL-c levels had significant nonlinear associations with fracture risk.
The number and size of VLDL and HDL particle size were positively associated with risk.
Elevated levels of lipids and lipoproteins are associated with hip fracture risk, suggesting an unexpected protective benefit of lipid-lowering medications in people with elevated LDL-c levels.

Summary

Background

It is unclear whether lipids or lipoproteins are associated with osteoporotic fractures. In this study, the risk of incident hip fracture was examined according to conventional lipid levels and lipoprotein levels and sizes.

Methods

We followed 5832 participants aged ≥65 years from the Hip Fracture Cardiovascular Health Study 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 participants per year [95% CI, 1.04, 1.35]) and 197 among men (0.67 fractures per 100 participants per year [95% CI , 0.41, 1.10]) during an average follow-up -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 joint 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 larger HDL-P size (HR per 1-SD increment 1.81 [1.25, 2.62]) were associated with an increased risk of hip fracture.

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.

Lipid-Lowering Drugs Suggest Unexpected Protective Benefit Against Hip Fracture Risk

Lipid-lowering drugs are associated with an unexpected protective benefit against the risk of hip fracture, challenging conventional perceptions of their effects on bone health and highlighting potential therapeutic implications.