Author Interviews, Hip Fractures, Lipids / 20.01.2023
Higher HDL-C levels Associated With Increased Fracture Risk
MedicalResearch.com Interview with:
[caption id="attachment_59929" align="alignleft" width="133"]
Dr. Hussain[/caption]
Dr Monira Hussain
Senior Research Fellow &
ECF Clinical Research Australian Fellow
Public Health and Preventive Medicine
Monash University
Melbourne VIC
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.
Dr. Hussain[/caption]
Dr Monira Hussain
Senior Research Fellow &
ECF Clinical Research Australian Fellow
Public Health and Preventive Medicine
Monash University
Melbourne VIC
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.
Dr. LeBoff[/caption]
Meryl S. LeBoff, MD
Dr. Manson[/caption]
JoAnn E. Manson, MD, DrPH
Professor, Epidemiology, Harvard T.H. Chan School Of Public Health
Michael and Lee Bell Professor of Women's Health, Medicine, Harvard Medical School
Chief, Preventive Medicine, Brigham And Women's Hospital
Co-Director, Womens Health, Brigham And Women's Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Osteoporosis is a major public health problem. Although supplemental vitamin D has been widely used to reduce the risk of fractures in the general population, studies of the effects of vitamin D on fractures, the most important bone health outcome, have been conflicting.
Randomized controlled trials, the highest quality studies, from around the world have shown benefit, no effect, or even harm of supplemental vitamin D on risk of fractures. Some of the trials used bolus dosing, had small samples sizes or short study duration, and co-administered calcium. No large RCTS of this scale tested whether daily supplemental vitamin D (without co-administration with calcium) prevented fractures in the US population.
To fill these knowledge gaps, we tested the hypothesis in this ancillary study to VITAL, whether daily supplemental vitamin D3 reduced the risk of incident total, non-spine and hip fractures in women and men in the US.
Dr. Margaret Gourlay[/caption]
MedicalResearch.com Interview with:
Margaret L. Gourlay, MD, MPH
Assistant Professor
UNC Department of Family Medicine
Chapel Hill, NC 27599-7595
Medical Research: What is the background for this study? What are the main findings?
Dr. Gourlay: While clinical practice guidelines universally recommend bone density screening for fracture prevention in women aged 65 years and older, minimal data exist to guide bone density screening in older men. We studied how often bone density screening tests should be ordered in men, using data from the Osteoporotic Fractures in Men (MrOS) Study. MrOS is the largest and longest-running (since 2000) US study of bone density and fracture in men aged 65 and older.
After peak bone mass is reached in young adulthood, both men and women lose bone density as they get older. Based on our earlier findings in older women, we expected that men aged 65 and older with higher bone density T-score measurements (T-score >-1.50) on a first (baseline) bone density test would have a substantially longer estimated time to develop the lowest level of bone density (osteoporosis) than men with better baseline measurements. Clinicians want to know the time to osteoporosis because they prescribe osteoporosis treatments to prevent future fractures in elderly patients.
As expected, we found that the men with higher baseline bone density had a much slower transition to osteoporosis compared to men with lower bone density. In fact, only nine out of 4203 (0.2%) of men with higher baseline bone density developed osteoporosis after an average of 8.7 years of bone density follow-up. That was much lower than we expected and is good news for men who have favorable scores on their first bone density test. Men who had lower baseline bone density measurements developed osteoporosis faster.
Unfortunately, maintaining bone density above the osteoporosis range did not guarantee that men remained fracture-free. Most of the major osteoporotic fractures (broken hip, spine, wrist or upper arm/shoulder) occurred in men who did not have osteoporosis. This might be because they had accidents or injuries that broke their bones despite their bone density being above the thinnest range.
