Liu Changzhi, Tong He, Gao Xifa, Wang Jiangchuan, Wei Zicheng, Wang Yu, Wang Jianhua, Chen Xiao
Department of Radiology, Funan County People's Hospital, Funan Hospital Affiliated with the Medical College of Fuyang Normal University, Fuyang, China.
Department of Radiology, Second Affiliated Hospital of Bengbu Medical University, Bengbu, China.
PLoS One. 2025 Jul 29;20(7):e0327171. doi: 10.1371/journal.pone.0327171. eCollection 2025.
Serum lipid levels have been shown to influence bone mineral density. Additionally, a limited number of studies have suggested that remnant cholesterol (RC) may be linked to the risk of osteoporosis. However, the relationship between RC and fracture risk remains unclear. This study aimed to explore the association between RC levels and the risk of vertebral fractures in a longitudinal cohort.
A total of 1995 participants aged 50 years or older who underwent chest computed tomography (CT) scans for lung cancer screening between July 2016 and December 2019 were included in this study. Follow-up continued until June 2023. The concentration of RC was calculated via the following formula: total cholesterol minus the sum of high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. The RC-to-cholesterol ratio was also determined. The participants were divided into low and high groups for RC, and the RC-to-cholesterol ratio was based on the median values. Vertebral fractures were assessed via the Genant semiquantitative classification system on CT-reconstructed sagittal images.
During a median follow-up period of 60 months, 95 new vertebral fractures were recorded. The incidence of fractures was significantly greater among participants with low RC levels than among those with high RC levels (6.4% vs. 3.1%, P < 0.01). A multivariate Cox proportional hazards model indicated that individuals with high RC levels had a 41% lower risk of vertebral fractures than those with low RC levels did (adjusted hazard ratio [aHR]: 0.48, 95% confidence interval [CI]: 0.24--0.93). Similar findings were observed for the RC-to-cholesterol ratio (aHR: 0.40, 95% CI: 0.21-0.79). Restricted cubic spline analysis further demonstrated that the risk of vertebral fractures decreased as the RC level and the RC-to-cholesterol ratio increased. Subgroup analysis revealed that the association between RC and fracture risk was mainly observed in women.
Higher levels of remnant cholesterol and a higher RC-to-cholesterol ratio were associated with a reduced risk of vertebral fractures, particularly in women.
血清脂质水平已被证明会影响骨密度。此外，少数研究表明，残余胆固醇（RC）可能与骨质疏松症风险有关。然而，RC与骨折风险之间的关系仍不清楚。本研究旨在探讨纵向队列中RC水平与椎体骨折风险之间的关联。
本研究纳入了2016年7月至2019年12月期间因肺癌筛查接受胸部计算机断层扫描（CT）的1995名50岁及以上参与者。随访持续至2023年6月。RC浓度通过以下公式计算：总胆固醇减去高密度脂蛋白胆固醇和低密度脂蛋白胆固醇之和。还确定了RC与胆固醇的比值。参与者按RC水平分为低、高两组，RC与胆固醇的比值以中位数为依据。通过CT重建矢状图像上的Genant半定量分类系统评估椎体骨折。
在中位随访期60个月内，记录到95例新发椎体骨折。RC水平低的参与者骨折发生率显著高于RC水平高的参与者（6.4%对3.1%，P<0.01）。多变量Cox比例风险模型表明，RC水平高的个体椎体骨折风险比RC水平低的个体低41%（调整后风险比[aHR]：0.48，95%置信区间[CI]：0.24-0.93）。RC与胆固醇比值也有类似发现（aHR：0.40，95%CI：0.21-0.79）。限制立方样条分析进一步表明，椎体骨折风险随着RC水平和RC与胆固醇比值的增加而降低。亚组分析显示，RC与骨折风险之间的关联主要在女性中观察到。
较高的残余胆固醇水平和较高的RC与胆固醇比值与较低的椎体骨折风险相关，尤其是在女性中。
