Cumulative exposure to remnant cholesterol and the risk of fragility fractures: a longitudinal cohort study

Xiaoli Hou; Nan Zhang; Lu Guo; Yongheng Wang; Mengyi Zheng; Shuohua Chen; Peipei Liu; Mengqin Wang; Jia Li; Shouling Wu; Faming Tian

doi:10.3389/fendo.2023.1251344

Cumulative exposure to remnant cholesterol and the risk of fragility fractures: a longitudinal cohort study

Front Endocrinol (Lausanne). 2023 Nov 28:14:1251344. doi: 10.3389/fendo.2023.1251344. eCollection 2023.

Authors

Xiaoli Hou^#¹, Nan Zhang^#², Lu Guo^#¹, Yongheng Wang¹, Mengyi Zheng³, Shuohua Chen⁴, Peipei Liu¹, Mengqin Wang⁵, Jia Li⁶, Shouling Wu⁴, Faming Tian¹

Affiliations

¹ School of Public Health, North China University of Science and Technology, Tangshan, China.
² Orthopedics Department, Kailuan General Hospital, Tangshan, China.
³ Cardiology Department, Capital Medical University, Beijing, China.
⁴ Cardiology Department, Kailuan General Hospital, Tangshan, China.
⁵ Emergency Department, Jishuitan, The Fourth Clinical Hospital of Peking University, Beijing, China.
⁶ Jitang College, North China University of Science and Technology, Tangshan, China.

^# Contributed equally.

Abstract

Objective: To investigate the association between cumulative remnant cholesterol (cumRC) and the risk of new-onset fragility fractures.

Methods: This study included individuals who participated in the 2006, 2008, and 2010 Kailuan health examinations. Baseline characteristics were compared between groups according to cumRC quartiles. The incidence density was calculated, and the log-rank test was used to compare the cumulative incidence. Cox proportional hazards models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI), and restricted cubic spline was used to examine the possibly non-linear relation between cumRC and the risk of fragility fractures. Additional analyses were performed with stratification by age (≥ or <65 years).

Results: A total of 43,839 individuals were included in this study. During the median follow-up period of 10.97 years, a total of 489 fragility fractures occurred. Multivariable Cox proportional hazards regression model 3 showed that the Q1 and Q4 groups versus the Q2 group were associated with a higher HR of fragility fracture (HR 1.61, 95% CI: 1.23-2.11; HR 1.38, 95% CI: 1.06-1.81), and restricted cubic spline regression analysis showed a non-linear relationship between cumRC level and the risk of fragility fractures (P _{Overall association} < 0.001, P _{Non-linear association} = 0.001). The association was significant in the age group <65 years but not in the age group ≥65 years. The sensitivity analyses were consistent with the main results.

Conclusions: Both too high and too low cumRC levels were associated with a greater risk of fragility fractures, and this association was more significant in young and middle-aged people.

Keywords: bone metabolism; cohort study; cumulative exposure; fragility fractures; remnant cholesterol.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cohort Studies
Fractures, Bone* / etiology
Humans
Incidence
Longitudinal Studies
Middle Aged
Regression Analysis

Grants and funding

This work was supported by The Central Government Guides Local Governments to Fund Development Projects (grant number 226Z7709G), Nature Science Foundation of Hebei Province (grant number H2022209054), Basic Scientific Research Funds Program of Universities in Hebei Province (grant number JYG2021005), Project of Innovation Ability Cultivation for Graduate Students in Hebei Province (grant number CXZZBS2022106), and Nature Science Foundation of Hebei Province (grant number H2020209266).