Association between arteriosclerosis index and lumbar bone mineral density in U.S adults: a cross-sectional study from the NHANES 2011-2018.

BACKGROUND

The arteriosclerosis index, defined as the ratio of non-high density lipoprotein cholesterol to high density lipoprotein cholesterol (NHHR), has emerged as a novel biomarker for various diseases. The relationship between NHHR and lumbar bone mineral density (BMD) has not been previously examined.

METHODS

This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. NHHR was calculated as (total cholesterol-high-density lipoprotein cholesterol)/high-density lipoprotein cholesterol. Lumbar BMD was calculated to scores. Weighted multivariate linear regression, subgroup analysis, interaction analysis, generalized additive model, and two-piecewise linear regression were used.

RESULTS

A total of 8,602 participants were included. The negative association between NHHR and lumbar BMD was consistent and significant (Model 1:  = -0.039, 95% CI: -0.055, -0.023,  < 0.001; Model 2:  = -0.045, 95% CI: -0.062, -0.027, < 0.001; Model 3:  = -0.042, 95% CI: -0.061, -0.023,  < 0.001). The linear relationship between NHHR and lumbar BMD was significantly influenced by body mass index ( for interaction = 0.012) and hypertension ( for interaction 0.047). Non-linear associations between NHHR and lumbar BMD scores were observed in specific populations, including U-shaped, reverse U-shaped, L-shaped, reverse L-shaped, and U-shaped relationships among menopausal females, underweight participants, those with impaired glucose tolerance, those with diabetes mellitus and those taking anti-hyperlipidemic drugs, respectively.

CONCLUSIONS

NHHR exhibited a negative association with lumbar BMD, but varying across specific populations. These findings suggest that NHHR should be tailored to individual levels to mitigate bone loss through a personalized approach. Individuals at heightened risk of cardiovascular disease should focus on their bone health.