Lipid Profile and Risk of Bone Fracture: A Systematic Review and Meta-Analysis of Observational Studies

ABSTRACT

Purpose: Earlier studies have linked lipid profile to osteoporotic fractures; however, to our knowledge, no study had summarized available data on this relationship. We aimed to summarize the current evidence on the association between lipid profile and bone fractures.

Material and Methods: A systematic search of PubMed and Scopus was done to find relevant published studies until March 2018. To combine effect sizes, we applied fixed- or random-effects analysis, where appropriate. Cochran’s Q test and I² were used to assess between-study heterogeneity.

Results: Overall, 11 studies (seven prospective, three cross-sectional and one case-control studies) were included in the current systematic review. Out of them, 10 studies with a total sample size of 60,484 individuals, aged 25 years or more, were used in the meta-analysis. The results showed that total cholesterol concentration was positively associated with risk of bone fracture; such that a 50-mg/dl increase in plasma level of TC was associated with 15% greater odds of bone fracture (combined effect size: 1.15, 95% CI: 1.02–1.30, P = .02). Furthermore, we found that individuals with a decreased level of HDL (<40 mg/dl) had a lower risk of bone fracture compared with those with a normal level (≥40 mg/dl) (combined effect size: 0.82, 95% CI: 0.71–0.96, P = .01). No significant association was found between plasma level of TG and LDL with the risk of bone fractures either in prospective or cross-sectional studies.

Conclusions: We found that plasma levels of total cholesterol were positively associated with bone fractures. In addition, decreased levels of HDL were associated with an increased risk of osteoporotic fractures.

Abbreviations: TG: triglycerides, TC: total cholesterol, HDL: high-density lipoprotein, LDL: low-density lipoprotein, OR: odds ratio, RR: relative risk, HR: hazard ratio, DXA: dual-energy X-ray absorptiometry, ICD: International Classification of Diseases, SD: standard deviation.

KEYWORDS:

• Cholesterol
• lipoproteins
• high-density lipoprotein
• bone fracture
• meta-analysis

Author contribution

SGH, OS, SRK, SS-b, and KDj contributed in conception, design, statistical analyses, data interpretation and manuscript drafting. SGH, OS, and MN contributed to data analysis, data interpretation, and manuscript drafting. SS-b and KDj finalized the manuscript. All authors approved the final manuscript for submission.

Conflicts of interest

Authors declared no personal or financial conflicts of interest.

Additional information

Funding

This research was financially supported by Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.