The prospective association between high-density lipoprotein (HDL) cholesterol and risk of incident fractures in the general population
Sutton, Richard LU ; Rogmark, Cecilia LU ; Fedorowski, Artur LU
; Hamrefors, Viktor
LU
and Johansson, Madeleine
LU
(2025)
In Osteoporosis International
- Abstract
- Summary
Elevated HDL-C levels are generally regarded as prognostically favorable in cardiovascular disease. Our study shows that higher HDL cholesterol levels are prospectively associated with 18% increased risk of new-onset fractures in men but not in women. Higher HDL cholesterol may be a novel risk factor for developing fractures in men.
Purpose
Increased high-density lipoprotein cholesterol (HDL-C) is associated with reduced risk of cardiovascular disease but inversely associated with bone mineral density.
Methods
We assessed the relationship between HDL-C and incident fractures using a prospective population-based cohort. In total 18,240 subjects had available data on HDL-C levels (mean age 69 years, 37%... (More) - Summary
Elevated HDL-C levels are generally regarded as prognostically favorable in cardiovascular disease. Our study shows that higher HDL cholesterol levels are prospectively associated with 18% increased risk of new-onset fractures in men but not in women. Higher HDL cholesterol may be a novel risk factor for developing fractures in men.
Purpose
Increased high-density lipoprotein cholesterol (HDL-C) is associated with reduced risk of cardiovascular disease but inversely associated with bone mineral density.
Methods
We assessed the relationship between HDL-C and incident fractures using a prospective population-based cohort. In total 18,240 subjects had available data on HDL-C levels (mean age 69 years, 37% women, mean follow-up 13 years). Fracture endpoints were identified through national registers. Follow-up was from 2002 until the first episode of incident fracture or end of follow-up December 31, 2020. The primary and secondary outcomes were total incident fractures and incident fractures of the hip and lower limb, respectively.
Results
Incident fractures occurred in 26% (n = 4,710) of all subjects (mean follow-up of 13 years). Subjects with incident fractures had higher HDL-C levels (mmol/L ± standard deviation) compared with subjects without fractures (1.5 ± 0.4 vs. 1.4 ± 0.4 mmol/L). In multivariate regression analysis, higher HDL-C levels were associated with increased risk of total incident fractures in the general population (HR 1.12, 95%CI 1.03–1.22, p = 0.006), and in men (HR 1.18, 95%CI 1.04–1.35, p = 0.02). No statistically significant relationship was found in women or between incident fractures of hip and lower limb fractures (p > 0.05).
Conclusions
Higher HDL cholesterol levels are prospectively associated with 18% increased risk of new-onset fractures in men from the general population but not in women. Higher HDL cholesterol may be a novel risk factor for developing fractures in men. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/61b7d7db-e5fa-4aa5-89ca-9f040233577d
- author
- Sutton, Richard
LU
; Rogmark, Cecilia
LU
; Fedorowski, Artur
LU
; Hamrefors, Viktor
LU
and Johansson, Madeleine
LU
- organization
- publishing date
- 2025-10
- type
- Contribution to journal
- publication status
- epub
- subject
- in
- Osteoporosis International
- publisher
- Springer
- external identifiers
-
- pmid:41171459
- ISSN
- 1433-2965
- DOI
- 10.1007/s00198-025-07732-6
- language
- English
- LU publication?
- yes
- id
- 61b7d7db-e5fa-4aa5-89ca-9f040233577d
- alternative location
- https://link.springer.com/10.1007/s00198-025-07732-6
- date added to LUP
- 2025-10-31 12:15:54
- date last changed
- 2025-11-03 08:09:14
@article{61b7d7db-e5fa-4aa5-89ca-9f040233577d,
abstract = {{Summary<br/>Elevated HDL-C levels are generally regarded as prognostically favorable in cardiovascular disease. Our study shows that higher HDL cholesterol levels are prospectively associated with 18% increased risk of new-onset fractures in men but not in women. Higher HDL cholesterol may be a novel risk factor for developing fractures in men.<br/><br/>Purpose<br/>Increased high-density lipoprotein cholesterol (HDL-C) is associated with reduced risk of cardiovascular disease but inversely associated with bone mineral density.<br/><br/>Methods<br/>We assessed the relationship between HDL-C and incident fractures using a prospective population-based cohort. In total 18,240 subjects had available data on HDL-C levels (mean age 69 years, 37% women, mean follow-up 13 years). Fracture endpoints were identified through national registers. Follow-up was from 2002 until the first episode of incident fracture or end of follow-up December 31, 2020. The primary and secondary outcomes were total incident fractures and incident fractures of the hip and lower limb, respectively.<br/><br/>Results<br/>Incident fractures occurred in 26% (n = 4,710) of all subjects (mean follow-up of 13 years). Subjects with incident fractures had higher HDL-C levels (mmol/L ± standard deviation) compared with subjects without fractures (1.5 ± 0.4 vs. 1.4 ± 0.4 mmol/L). In multivariate regression analysis, higher HDL-C levels were associated with increased risk of total incident fractures in the general population (HR 1.12, 95%CI 1.03–1.22, p = 0.006), and in men (HR 1.18, 95%CI 1.04–1.35, p = 0.02). No statistically significant relationship was found in women or between incident fractures of hip and lower limb fractures (p > 0.05).<br/><br/>Conclusions<br/>Higher HDL cholesterol levels are prospectively associated with 18% increased risk of new-onset fractures in men from the general population but not in women. Higher HDL cholesterol may be a novel risk factor for developing fractures in men.}},
author = {{Sutton, Richard and Rogmark, Cecilia and Fedorowski, Artur and Hamrefors, Viktor and Johansson, Madeleine}},
issn = {{1433-2965}},
language = {{eng}},
publisher = {{Springer}},
series = {{Osteoporosis International}},
title = {{The prospective association between high-density lipoprotein (HDL) cholesterol and risk of incident fractures in the general population}},
url = {{http://dx.doi.org/10.1007/s00198-025-07732-6}},
doi = {{10.1007/s00198-025-07732-6}},
year = {{2025}},
}