Increased fracture risk linked to high HDL-C levels

Jan. 23, 2023

High levels of high-density lipoprotein cholesterol (HDL-C) in older adults are associated with a higher risk of sustaining a fracture than those with lower HDL-C levels, a new study suggests.

“Two animal studies showing that HDL-C reduces bone mineral density by reducing osteoblast number and function provide a plausible explanation for why high HDL-C may increase the risk of fractures,” Monira Hussain, MBBS, MPH, PhD of Monash University in Melbourne, Australia told | Medscape Cardiology. “So, it was not surprising when our analyses provided evidence that amongst those in the highest quintile of HDL-C (>74 mg/dL), there was a [33%] increased risk of fractures.” 

After adjustment, one standard deviation increment in HDL-C level was associated with a 14% higher risk of fracture during a four-year follow-up. 

Based on this and other studies, Hussain said, "I believe that the finding of a very high HDL-C [should] alert clinicians to a higher risk of mortality, fractures, and possibly other threats to their patient's health." 

The study was published online January 18 in JAMA Cardiology. For this report, the researchers conducted a post-hoc analysis of data from the Aspirin in Reducing Events in the Elderly (ASPREE) clinical trial and the ASPREE-Fracture substudy. 

ASPREE was a double-blind, randomized, placebo-controlled primary prevention trial of aspirin. Participants were 16,703 community-dwelling Australians and 2,411 individuals from the U.S. with a mean age of 75 and without evident cardiovascular disease, dementia, physical disability, or life-limiting chronic illness. 

The ASPREE-Fracture substudy collected data on fractures reported post-randomization from the Australian participants. Fractures were confirmed by imaging and adjudicated by an expert panel and included both traumatic and minimal trauma fractures. 

The increase in fracture risk appeared to be independent of traditional risk factors for fractures, including age, sex, physical activity, alcohol use, frailty, BMI, smoking status, diabetes, chronic kidney disease, use of lipid-lowering or anti-osteoporosis drugs, and education, the authors noted. 

Medscape Medical News release