20 Jan Higher HDL-C levels Associated With Increased Fracture Risk
MedicalResearch.com Interview with:
Dr Monira Hussain
Senior Research Fellow &
ECF Clinical Research Australian Fellow
Public Health and Preventive Medicine
MedicalResearch.com: What is the background for this study?
Response: 25% of males and 44% of females aged 60 years or over experience minimal trauma fractures. Minimal trauma fractures are a clinical outcome of osteoporosis and may occur following little or no trauma i.e. fractures following a fall from standing height or less. Minimal trauma fractures are silent, people may not notice that they are at high risk of the disease until a bone is broken.
I was aware of previous studies reporting that high-density lipoprotein cholesterol (HDL-C) was elevated in patients with osteoporosis. 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.
Our study, the ASPirin in Reducing Events in the Elderly (ASPREE), and the ASPREE fracture substudy provide unique data that could determine whether these findings might apply to fracture risk in healthy older adults. The study collected data including HDL-C levels and fractures from more than 16,000 community-dwelling older adults. These participants were followed-up for a median of 4 years.
MedicalResearch.com: What are the main findings? Were the patients in this cohort more/less physically active which could impact risk of fractures?
Response: We found that higher rates of fractures occurred amongst those in the highest quintile of HDL-C (>74 mg/dL). Levels of HDL-C in this range predicted a 33% increased fracture risk over the subsequent four years.
These are community-based healthy people thus their levels of physical activity should reflect the normal physical activity that an older person would partake in on a regular basis. We found that in the less physically active participants who were in the highest quintile of HDL-C, there was a 42% increased risk of fracture.
MedicalResearch.com: What should readers take away from your report?
Response: Our findings add to growing evidence of unfavorable impacts linked to high HDL-C levels. It shows that HDL-C commonly known as ‘good cholesterol’ in high levels is not as good as we previously thought.
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: Future studies should concentrate on mechanisms of how raised HDL-C levels increase fracture risk. Also, whether levels of HDL-C could become part of a screen for fracture risk.
MedicalResearch.com: Is there anything else you would like to add? Any disclosures?
Response: The ASPirin in Reducing Events in the Elderly (ASPREE) study was supported by grants from the National Institute on Aging and the National Cancer Institute at the National Institutes of Health (U01AG029824); the National Health and Medical Research Council of Australia (334037 and 1127060); Monash University (Melbourne, VIC, Australia); and the Victorian Cancer Agency (Australia). The ASPREE-Falls & Fractures sub-study was supported by a grant from the National Health and Medical Research Council (NHMRC) of Australia (1067242). The sponsor had no role in the design and conduct of this study; collection, management, analysis, and interpretation of the data and decision to submit the manuscript for publication but was given the opportunity to review and comment on the manuscript.
Dr Hussain is the recipient of NHMRC Early Career Fellowship (APP1142198), and Professor McNeil is supported through an NHMRC Leadership Fellowship (IG 1173690). No other disclosures are reported by the other authors.
Hussain SM, Ebeling PR, Barker AL, Beilin LJ, Tonkin AM, McNeil JJ. Association of Plasma High-Density Lipoprotein Cholesterol Level With Risk of Fractures in Healthy Older Adults. JAMA Cardiol. Published online January 18, 2023. doi:10.1001/jamacardio.2022.5124
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